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Scalp flaps

Marco Ellis, Lisa Hwang, Ni-Ka Ford, Konstantin Slavin
BACKGROUND: Full-thickness scalp defects pose a reconstructive problem, especially in the setting of infection, chemotherapy/radiation, and underlying cranial defects. Current options include dermal matrices, skin grafts, and local flaps. Local flaps often fail, requiring subsequent microvascular free flap reconstruction. OBJECTIVE: To describe the visor flap, a novel bipedicled advancement flap design, and its role in reconstruction of scalp defects. METHODS: A retrospective review of 21 adult patients who developed scalp defects reconstructed using the visor flap from 2013 to 2017...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
Aderaldo Costa Alves Junior, Pedro Tadao Hamamoto Filho, Marcelo Pacheco Gonçalves, Aristides Augusto Palhares Neto, Marco Antonio Zanini
Cranioplasty is a common procedure in neurosurgical practice, but associated with high complication rates. In the current study, the authors describe surgical characteristics and results of cranioplasty performed in a tertiary teaching hospital in Brazil. Data were obtained from electronic medical records of cranioplasties performed between January 2013 and November 2016. The sample comprised of 33 patients, and the mean follow-up time was 16 months. Patients presented most of the times a good preoperative status, with 84...
March 16, 2018: Journal of Craniofacial Surgery
Stephen L Viviano, Farrah C Liu, Paul J Therattil, Edward S Lee, Jonathan D Keith
BACKGROUND: Thinning of anterolateral thigh (ALT) flaps has been described to achieve optimal contouring. Previous studies caution against thinning large flaps owing to the risk of vascular compromise leading to partial or total flap necrosis. This study aims to demonstrate a reliably safe method for thinning extra-large (>240 cm) flaps. METHODS: A retrospective review of 53 consecutive ALT flaps performed at a single institution was completed. Of these flaps, 18 (34%) were thinned primarily by sharp excision of sub-Scarpa's fat along the periphery of the flap using loupe magnification...
March 16, 2018: Annals of Plastic Surgery
Muralidhar Pai K, R Chandrasekhar Naidu, A Raja, Y S Rai, Niranjan Kumar, Anand Kini, Santhosh Joseph, Vinod Hegde, H S Ballal, Ramoorthi Rao, Saroja V Sharma, Vinay Kumar Valakatte
Craniopagus twins are conjoined twins fused at the cranium. This is the rarest anomaly seen in conjoined twins and craniopagus twins account for 2- 6% of conjoined twins. Conjoined twins are also extremely rare, with the anomaly seen in about 10-20 subjects per billion births. A female preponderance has been noted. Craniopagus twins can be classified into complete or partial, depending on whether or not they have shared dural venous sinuses. They can be further classified into angular or total depending on the alignment of the inter-twin longitudinal axis...
March 2018: Neurology India
Sheng Yan, Hangyan Shi, Da Chen, Jincai Guo, Yi Sun, Sufan Wu
The reconstruction of large full-thickness scalp defects remains a surgical challenge, especially when the skull is exposed completely without periosteum. Surgical technique options for wound coverage have included tissue expansion, skin grafting, local or regional flaps, and microvascular free tissue transfer. In recent years, some authors have reported to use biological material as an alternative for repairing complex wounds. The authors report the successful reconstruction of a large defect with bare skull in bilateral temporal regions of a 3-year-old child...
March 14, 2018: Journal of Craniofacial Surgery
Karolien Hollanders, Ingele Casteels, Sylvie Vandelanotte, Rudolf Reyniers, Katarina Segers, Thomas Nevens, Ilse Mombaerts
PURPOSE: To report a case of ablepharon-macrostomia syndrome and surgical treatment options. METHODS: Case report and literature review. RESULTS: A prematurely born male baby presented with severe ablepharon, hypertelorism, macrostomia, low-set dysplastic ears, broad nasal bridge, coarse and redundant body skin, absent scalp and body hair, lax abdominal wall, absent nipples, camptodactyly, and ambiguous genitalia. Despite intensive ocular lubrication, severe exposure keratopathy developed within the first days after birth...
March 13, 2018: Cornea
Masanori Yoshino, Takayuki Hara
Intraoperative monitoring of visually evoked potentials (VEPs) is sometimes unachievable because of light axis misalignments caused by frontal scalp-flap reflection and intraoperative manipulation. Here, we present a new method of intraoperative VEP monitoring that involves a sterilised photostimulation device that can be adjusted in position following disturbances from frontal scalp-flap reflection or intraoperative manipulation.
March 9, 2018: British Journal of Neurosurgery
Haifeng Zhu, Chengfu Ji, Zhouming Shen, Zhengxiang Luo, Lei Shi
OBJECTIVE: Obvious skin flap collapse is often accompanied by reduced neurological recovery after decompressive craniectomy. This study explored the feasibility of early cranioplasty (EC) in patients with obvious bilateral frontotemporal bone window (BFBW) collapse after decompressive craniectomy. METHODS: Patients with obvious BFBW collapse who underwent EC or traditional cranioplasty (TC) were divided into three groups according to their preoperative Glasgow Coma Scale (GCS) scores...
February 23, 2018: World Neurosurgery
Hua Shen, Xinyi Dai, Jun Chen, Jing Wang, Zhaofen Zhang, Zhengdong Cai
Reconstruction of scalp defects caused by tumor resection or trauma is very challenging. A majority of the surgeons prefer to use local flap rather than skin graft or free flap for scalp defects repair. The aim of this study is to investigate the technique of modified unilateral pedicled V-Y advancement flap for the reconstruction of scalp defect.A retrospective review was performed in a series of 18 patients who had a modified unilateral pedicled V-Y advancement flap to restore scalp defect from May 2013 to January 2017...
February 14, 2018: Journal of Craniofacial Surgery
Jin Woo Kim, Soo Hyun Woo, Suk Yoon Jang, Woo Seob Kim, Tae Hui Bae, Han Koo Kim
Most patients with reconstruction for extensive scalp defects require the use of a free flap. The suitability of the recipient vessel has a major impact on the surgery and postoperative outcome. Flaps that can be used to reconstruct the total scalp with a single flap include the latissimus dorsi (LD) and omental flaps; the LD flap is generally preferred since the omental flap results in relatively larger donor site morbidity. The recipient vessel most commonly used for scalp defect reconstruction is the superficial temporal vessel...
February 14, 2018: Journal of Craniofacial Surgery
Osman Akdag
PURPOSE: The exposure of a ventriculoperitoneal shunt on the scalp is a serious complication. There are limited studies evaluating this complication's management in the literature. The aim of this study is to define the management of shunt salvage and the reconstruction of the scalp. METHODS: This retrospective study included seven pediatric patients with ventriculoperitoneal shunts that were exposed on the scalp for various reasons. The demographic characteristics of the patients and the medical and surgical treatments used were recorded...
February 2, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Kadir Serkan Orhan, Jaydip Ray, Beldan Polat, Simon Carr, Necati Enver, Javier Moraleja Deleito, Larissa Greenwood, Yahya Güldiken
The authors describe the use of superiorly curved scalp Incision for Implantation of Magnetic Transcutaneous Bone Conduction Devices They describe a new technical aspect to minimise numbness issues in a series of 60 patients from two tertiary referral centres. An inferiorly-based flap design will help to preserve branches of the great auricular and lesser occipital nerves, which normally sacrificed with the original technique. Superiorly curved scalp Incision will be suitable for subsequent retroauricular incision that is used in auricular reconstruction in microtia patients...
January 27, 2018: Clinical Otolaryngology
Michael D Staudt, Navid Pourtaheri, Gregory E Lakin, Hooman T Soltanian, Jonathan P Miller
BACKGROUND: Scalp erosion in patients with deep brain stimulation (DBS) hardware is an uncommon complication that lacks a clearly defined management strategy. Previous studies have described various therapies including conservative treatment with antibiotics and surgical debridement with or without hardware removal. OBJECTIVES: The aim of this study was to review the efficacy of a hardware-sparing management strategy for the treatment of scalp erosion. METHODS: Five patients with previous DBS implantation presented with scalp erosion and visible hardware exposure at the calvarial burr hole site, and underwent tension-free, vascularized, rotational scalp flap, with preservation of the leads under the pericranium...
2017: Stereotactic and Functional Neurosurgery
Blionas Alexandros, Giakoumettis Dimitrios, Antoniades Elias, Drosos Evangelos, Mitsios Andreas, Plakas Sotirios, Sfakianos Georgios, Themistocleous S Marios
Background: Aplasia cutis congenita (ACC) is a part of a heterogeneous group of conditions characterized by the congenital absence of epidermis, dermis, and in some cases, subcutaneous tissues or bone usually involving the scalp vertex. There is an estimated incidence of 3 in 10,000 births resulting in a total number of 500 reported cases to date. The lesions may occur on every body surface although localized scalp lesions form the most frequent pattern (70%). Complete aplasia involving bone defects occurs in approximately 20% of cases...
2017: Surgical Neurology International
Min Su Kim, Ik Seong Park
BACKGROUND AND IMPORTANCE: The authors report a novel external scalp retraction technique for sunken skin flap syndrome (SSFS). CLINICAL PRESENTATION: A 48-year-old male patient suffered neurological deterioration due to SSFS after decompressive craniectomy. Cranioplasty is the gold standard for therapeutic management of SSFS, but could not be performed due to intracranial wound infection. The patient underwent external fixation of a metal plate as a frame for the skull and the scalp was pulled outward to the frame by skin suture...
December 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
Bernard Tan, Tee Sin Lee, Ian Loh
No abstract text is available yet for this article.
November 10, 2017: American Journal of Otolaryngology
Ririko Takeda, Hiroki Kurita
BACKGROUND: To reduce complications associated with conventional pterional craniotomy, a transsylvian keyhole approach for unruptured small anterior circulation aneurysms is proposed. METHODS: A 7-cm linear scalp incision is made along the hairline, beginning at the zygoma, followed by minimal temporal muscle dissection. Two burr holes are drilled out at McCarty's point and the temporal bone, and a 3-cm equilateral triangle bone flap is made, whose apex is located above the sylvian point...
November 14, 2017: Acta Neurochirurgica
Minerva H Zhou, Gavin P Dunn, Joshua W Osbun, DeWitte T Cross, Christopher J Moran, Ralph G Dacey, Akash P Kansagra
We report a case of renal cell carcinoma (RCC) metastasis to the calvarium and describe a strategy for percutaneous embolization of hypervascular calvarial tumors with intracranial extension. An elderly patient with history of RCC presented with left-sided weakness. Imaging studies showed a large right frontoparietal calvarial mass with intra- and extracranial extension. The tumor was devascularized by direct puncture tumor embolization using Onyx 18, allowing subsequent operative resection without significant blood loss or the need for flap reconstruction of the scalp...
January 1, 2017: Interventional Neuroradiology
Bikash Ranjan Behera, Sanjib Mishra, Deepak Das, Rajesh Gantayat
Even if human beings are the most intelligent among all living beings, they are still not immune to attack from wild animals. Human contact with bears has become more frequent as their habitat is being endangered by frequent deforestation. The sloth bear is one of the few bear species found in India, especially in the hilly areas of Southern Odisha. Bears are highly intelligent and omnivorous animals with long claws coupled with powerful shoulder. Here, we describe the tale of a poor tribal male's encounter with a sloth bear resulting in critical injuries to face, scalp, skull bone, with brain matter fungating-out of the skull...
October 2017: Asian Journal of Neurosurgery
M D Vilela, Has Pedrosa, Fd Sampaio, L J Carneiro
BACKGROUND: management of encephaloceles is challenging when massive brain herniation is present. In such instances, an expansile cranioplasty may be attempted so as to preserve some herniated brain tissue. Complications such as wound dehiscence, CSF leak and scalp necrosis are postoperative concerns. The treatment of scalp necrosis with dural and brain exposure is certainly a challenge, due to the complexity of flap techniques in such a young age. Herein we describe the use of a novel technique for the management of a scalp necrosis and dehiscence in an infant...
November 1, 2017: World Neurosurgery
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