Staggered setting of latissimus dorsi and serratus anterior flaps for the treatment of scalp avulsions: a retrospective study.

BACKGROUND: Although the incidence of scalp avulsion has decreased in recent years, it remains a major concern among plastic surgeons. We therefore aimed to introduce an improved free flap technique for repairing scalp avulsion with less tissue from the donor site. This method can achieve maximum primary closure of the donor site and improve its appearance and function as well as reduce the donor site morbidity by ensuring that a smaller free flap can completely cover the scalp defect.

METHODS: Eight patients with scalp avulsion who had undergone staggered placement of the free flaps were evaluated. Data on the age, cause of scalp avulsion, scalp defect size, degree of avulsion, postoperative complications, and follow-up duration were analyzed. The postoperative evaluation criteria were donor site sensation, latissimus dorsi muscle strength, upper extremity function, and quality of life.

RESULTS: Patients' mean age was 38.7 years. The main cause of scalp avulsion was occupation-related accidents. The mean scalp defect size and postoperative follow-up duration were 26 cm × 20.4 cm and 41.5 months, respectively. One patient developed flap congestion postoperatively. The wounds at the recipient site healed well in all patients. There was no significant difference in the sensation between the surgical and nonsurgical sides. However, the latissimus dorsi muscle strength significantly differed between both sides. The mental component score, which was used to assess quality of life, did not significantly differ between the patients and healthy population, whereas the physical component score significantly differed between the two groups. None of the included patients had severe upper extremity functional limitation.

CONCLUSION: Staggered placement of free flaps achieved maximum primary closure of the donor site and greater scalp avulsion defect coverage with less tissue excised from the donor site. Importantly, donor site appearance improved and some donor site functions were preserved postoperatively.