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An Algorithm for Oncologic Scalp Reconstruction

Iblher, Niklas M.D.; Ziegler, Matthias C. M.D.; Penna, Vincenzo M.D.; Eisenhardt, Steffen U. M.D.; Stark, G. Björn M.D.; Bannasch, Holger M.D.

Plastic and Reconstructive Surgery: August 2010 - Volume 126 - Issue 2 - p 450-459
doi: 10.1097/PRS.0b013e3181e09515

Background: Modern reconstructive surgery allows for radical resection and reconstruction of any scalp tumor. However, a significant number of patients are still not treated optimally because of incomplete reconstructive guidelines.

Methods: The treatment of scalp tumors was documented in 60 patients over a 10-year period. Data regarding tumor type, size, and localization; reconstructive procedure; oncologic, functional, and aesthetic outcome; and complications were collected and analyzed retrospectively. These data were correlated to recurrence and survival rates. The findings extracted from the data were amalgamated to produce the proposed reconstructive algorithm.

Results: Five reconstructive categories were defined and their application could be described in an algorithmic approach. Indications, limitations, and adequate reconstructive procedures for each category were identified. The most important decisions are when to use local flaps versus primary closure and when to use free tissue transfer.

Conclusions: Radical surgical resection and reconstruction presents the best available method to cure scalp tumors or to establish local disease control in palliative settings. The authors present an algorithm to assist in the planning process of oncologic scalp reconstruction. If this algorithm is applied, the occurrence of inadequate resections and the need for repeated procedures can be minimized.

Freiburg, Germany

From the Department of Plastic and Hand Surgery, University of Freiburg Medical Center.

Received for publication July 23, 2009; accepted January 13, 2010.

Presented in part at the German Society of Surgery Meeting, in Munich, Germany, April 21, 2009; and at the 10th Congress of the International Confederation for Plastic, Reconstructive, and Aesthetic Surgery/Asian Pacific Section, in Tokyo, Japan, October 8 through 10, 2009.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Niklas Iblher, M.D., Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Hugstetterstrasse 55, D-79106 Freiburg, Germany,

©2010American Society of Plastic Surgeons