RECONSTRUCTION OF REFRACTORY DEFECT OF SCALP AND SKULL USING MICROSURGICAL FREE-FLAP TRANSFER

Ten patients - six with acute burns, two with old accident or surgical trauma, and two with cranial carcinoma - experienced extensive full-t hickness necrosis of the scalp and necrosis or defect of underlying sk ull bone. Microsurgical free flaps were used for the repair. Four lati ssimus dorsi, two rectus abdominis, one greater omentum, one prefabric ated omentum-cutaneous flap, and two vascularized outer-table of the c ranial bone flaps were used with complete survival. The heat-devitaliz ed cranial bone covered by living tissue flaps healed well and substan tial ''regeneration'' of previously necrosed bone was shown by roentge nogram, bone scan, and histopathological examination in the postoperat ive follow-up. Choosing an artery with high perfusion, bypassing from the carotid artery to support a massive free flap, is recommended. (C) 1994 Wiley-Liss, Inc.