RECONSTRUCTION OF UPPER CRANIAL AND CRANIAL BASE DEFECTS UTILIZING THE SCALPING FLAP

Reconstruction of midfacial defects by means of a scalping flap has be en widely practiced and described in the literature. The advantages of the flap are familiar to sur geons who perform extirpations and recon struction of the head and neck and include contiguous availability, si mplicity of application, and a robust and redundant blood supply. Desp ite these merits, the flap has not been widely used for reconstruction s of large anterior cranial defects or defects of the cranial base. A retrospective review of 11 patients who underwent reconstructions betw een 1990 and 1995 was performed. In each case, a reconstruction of a l arge anterior cranial or cranial base defect was carried out. The resu lting soft tissue defect was restored via the scalping flap. In six ca ses, this was carried out in a single procedure. In five cases, flap d ivision and inserting were carried out in a subsequent procedure, foll owing a 1- to 2-week delay. In all cases, the extirpation and reconstr uction were well tolerated, and the average time of hospitalization wa s 5.9 days and ranged from 3 to 11 days. No major surgical complicatio ns occurred. One of 11 patients had a minor complication not requiring surgical intervention. There was one recurrence of a cranial base tum or approximately 2 years following the initial resection and reconstru ction. In all cases, the final aesthetic and functional results were a cceptable to excellent. Follow-up ranged from 11 months to 5 years. In conclusion, the scalping flap can be effectively utilized for soft-ti ssue coverage in the reconstruction of anterior cranial and cranial ba se defects. Use of this simple and versatile flap in craniofacial reco nstruction is well tolerated and is associated with a low morbidity, a good aesthetic result, and a short hospital stay.