Introduction: Soft-tissue reconstruction of the scalp has traditionally been challenging in oncologic patients. Invasive tumors can compromise the calvarium, necessitating alloplastic cranioplasty. Titanium mesh is the most common alloplastic material, but concerns of compromise of soft-tissue coverage have introduced hesitancy in utilization. The authors aim to identify prognostic factors associated with free-flap failure in the context of underlying titanium mesh in scalp oncology patients.
Methods: A retrospective review (2010-2018) was conducted at a single center examining all patients following oncologic scalp resection who underwent titanium mesh cranioplasty with free-flap reconstruction following surgical excision. Patient demographics, comorbidities, ancillary oncological treatment information were collected. Operative data including flap type, post-operative complications including partial and complete flap failure were collected.
Results: A total of 16 patients with 18 concomitant mesh cranioplasty and free-flap reconstructions were identified. The majority of patients were male (68.8%), with an average age of 70.5 years. Free-flap reconstruction included 15 ALT flaps (83.3%), 2 latissimus flaps (11.1%), and one radial forearm flap (5.5%). There were three total flap losses in two patients. Patient demographics and comorbidities were not significant prognostic factors. Additionally, post-operative radiation therapy, ancillary chemotherapy, oncological histology, tumor recurrence, and flap type were not found to be significant. Pre-operative radiotherapy was significantly associated with flap failure (P < 0.05).
Conclusion: Pre-operative radiotherapy may pose a significant risk for free-flap failure in oncologic patients undergoing scalp reconstruction following mesh cranioplasty. Awareness of associated risk factors ensures better pre-operative counseling and success of these reconstructive modalities and timing of pre-adjuvant treatment.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/SCS.0000000000006421 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Success of Bone Ossification After Posterior Vault Distraction Osteogenesis in Patients With Craniosynostosis.
J Craniofac Surg
November 2024
Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine.
Background: Posterior vault distraction osteogenesis (PVDO) is an effective treatment for multisuture and syndromic craniosynostosis. It remains unclear how well the calvarium ossifies after PVDO, especially in older patients when they have plateaued in their cranial growth phase. The purpose of this study is to report outcomes associated with PVDO across a wide range of ages at our institution.
View Article and Find Full Text PDFIntracranial Hypotension Mechanism and Implant Retention Procedure for Patients With Titanium Mesh Exposure.
Oper Neurosurg (Hagerstown)
January 2025
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Background And Objectives: The study aimed to investigate the potential pathogenesis and present an implant retention procedure for patients with titanium mesh exposure after cranioplasty.
Methods: The clinical data were obtained from 26 consecutive cases with titanium mesh exposure who underwent surgical treatment between 2018 and 2023. These patients' medical records, scalp photographs, operative notes, and outcomes were retrospectively analyzed.
Neglected growing skull fracture presenting in adulthood: A case report.
Int J Surg Case Rep
January 2025
Department of Radiology, B and B Hospital, Gwarko, Lalitpur, Nepal.
Introduction And Importance: Growing skull fracture is one the rarest complication of skull fracture. They are identified mostly in infancy and children's, secondary to head trauma but there exist possibility of missed diagnosis in childhood and patient presenting in adulthood with delayed complications. Hence timely diagnosis and prompt management is mandatory.
View Article and Find Full Text PDFChallenges in the Management of a Calvarial Defect in an NF1-Patient.
Diseases
December 2024
The Leo M. Davidoff Department of Neurological Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
Background: Calvarial defects in NF1 are rare and lack standardized management guidelines. This study seeks to shed light on calvarial defects in NF1 patients with extensive skull erosion.
Methods: This case report focuses on clinical and radiological presentations and surgical interventions during six years of follow-up, comparing the results with those in the literature.
Risk factors for complications following titanium mesh cranioplasty.
Acta Neurochir (Wien)
December 2024
Department of Neurosurgery, Rigshospitalet , Copenhagen University Hospital, Copenhagen, Denmark.
Background: Studies on complications following titanium mesh cranioplasty have predominantly focused on patients with cranial defects after decompressive craniectomy. This study investigates possible risk factors for complications using titanium mesh for smaller cranial defects.
Methods: All patients treated with titanium mesh cranioplasty over a 5-year period at Copenhagen University Hospital were identified.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!