PATIENTS WITH MALIGNANT brain tumors requiring multiple craniotomies and external beam radiotherapy are at risk of scalp wound breakdown secondary to fibrosis and radiation damage. We present three cases to illustrate the nature of the problem and the surgical approaches to scalp repair. When a bicoronal incision has been used for the initial craniotomy, the plastic repair can be performed with a bipedicle visor scalp flap and a split-thickness skin graft to cover the pericranium at the donor site. When a curvilinear (U-shaped or horseshoe) flap has been used for the initial craniotomy, a single-pedicle flap may be rotated to achieve closure without tension. In anticipation of the risk of scalp wound breakdown in patients with malignant brain tumors, the planning of the operative incision for the first craniotomy needs to take into account the long-term viability of the scalp. We recommend linear scalp incisions parallel to the arterial distribution instead of the traditional curvilinear (U-shaped or horseshoe) flaps; linear incisions are less likely to break down, and in the event of breakdown, linear wounds offer better therapeutic surgical options for plastic repair.
Department of Neurosurgery (SN, GG, TM, PB), and Division of Plastic and Reconstructive Surgery (MG, MS), Hahnemann University, Philadelphia, Pennsylvania
Reprint requests: Somnath Nair, M.D., Department of Neurosurgery, Mail Stop 407, Hahnemann University, Broad and Vine, Philadelphia, PA 19102-1192.
Received, January 22, 1993. Accepted, June 2, 1993.