Abstract：
BACKGROUND: Treatment of scalp malignancies may include the need for craniectomy. The decision to perform cranioplasty is not straightforward and is frequently subjective. The purpose of this study was to assess the clinical outcomes after reconstruction of complex scalp and calvarial defects by comparing patients with and without cranioplasty.
METHODS: Retrospective review of the clinical records of a consecutive series of patients who underwent scalp soft tissue reconstruction after craniectomy for malignancy or osteoradionecrosis between 2014 and 2022 at Royal Melbourne Hospital was conducted. Demographics, previous treatments, surgical details, and post-operative complications were assessed. Traumatic injuries and decompressive craniectomies were excluded. Minimum follow-up of 6 months.
RESULTS: Thirty-seven patients were included in the study. Indications for surgery included skin malignancies, osteoradionecrosis, or both. There was one reconstructive failure (in the non-cranioplasty group). Infection and metalware exposure were common complications in patients who underwent cranioplasty (38.5%). No patient developed neurological symptoms subsequent to craniectomy. One patient needed revision surgery due to esthetic reasons (cranioplasty group). Transposition flaps were associated with more complications and revision procedures.
CONCLUSIONS: Combined scalp and calvarial defects pose a difficult reconstructive challenge. Stable soft tissue coverage is more reliably achieved with free flap reconstruction. Cranioplasty is not always mandatory and should be reserved for cases with a very large bony defect or when the defect is located in a cosmetically sensitive area.
METHODS: Retrospective review of the clinical records of a consecutive series of patients who underwent scalp soft tissue reconstruction after craniectomy for malignancy or osteoradionecrosis between 2014 and 2022 at Royal Melbourne Hospital was conducted. Demographics, previous treatments, surgical details, and post-operative complications were assessed. Traumatic injuries and decompressive craniectomies were excluded. Minimum follow-up of 6 months.
RESULTS: Thirty-seven patients were included in the study. Indications for surgery included skin malignancies, osteoradionecrosis, or both. There was one reconstructive failure (in the non-cranioplasty group). Infection and metalware exposure were common complications in patients who underwent cranioplasty (38.5%). No patient developed neurological symptoms subsequent to craniectomy. One patient needed revision surgery due to esthetic reasons (cranioplasty group). Transposition flaps were associated with more complications and revision procedures.
CONCLUSIONS: Combined scalp and calvarial defects pose a difficult reconstructive challenge. Stable soft tissue coverage is more reliably achieved with free flap reconstruction. Cranioplasty is not always mandatory and should be reserved for cases with a very large bony defect or when the defect is located in a cosmetically sensitive area.
摘要：
背景：头皮恶性肿瘤的治疗可能包括需要进行颅骨切除术。进行颅骨成形术的决定并不简单，而且往往是主观的。这项研究的目的是通过比较有无颅骨成形术的患者，评估复杂头皮和颅骨缺损重建后的临床结果。
方法：回顾性回顾了2014年至2022年在皇家墨尔本医院接受恶性肿瘤或放射性骨坏死开颅术后头皮软组织重建的一系列连续患者的临床记录。人口统计,以前的治疗,手术细节,并对术后并发症进行评估。排除外伤和去骨瓣减压术。最少随访6个月。
结果：37例患者纳入研究。手术指征包括皮肤恶性肿瘤,骨坏死,或者两者兼而有之。有一次重建失败（非颅骨成形术组）。感染和金属制品暴露是颅骨修补术患者的常见并发症（38.5％）。没有患者在开颅手术后出现神经系统症状。一名患者由于美学原因需要进行翻修手术（颅骨成形术组）。转位皮瓣与更多的并发症和翻修程序相关。
结论：头皮和颅骨联合缺损构成了困难的重建挑战。通过游离皮瓣重建更可靠地实现稳定的软组织覆盖。颅骨成形术并不总是强制性的，应保留用于骨缺损非常大或缺损位于美容敏感区域的情况。
方法：回顾性回顾了2014年至2022年在皇家墨尔本医院接受恶性肿瘤或放射性骨坏死开颅术后头皮软组织重建的一系列连续患者的临床记录。人口统计,以前的治疗,手术细节,并对术后并发症进行评估。排除外伤和去骨瓣减压术。最少随访6个月。
结果：37例患者纳入研究。手术指征包括皮肤恶性肿瘤,骨坏死,或者两者兼而有之。有一次重建失败（非颅骨成形术组）。感染和金属制品暴露是颅骨修补术患者的常见并发症（38.5％）。没有患者在开颅手术后出现神经系统症状。一名患者由于美学原因需要进行翻修手术（颅骨成形术组）。转位皮瓣与更多的并发症和翻修程序相关。
结论：头皮和颅骨联合缺损构成了困难的重建挑战。通过游离皮瓣重建更可靠地实现稳定的软组织覆盖。颅骨成形术并不总是强制性的，应保留用于骨缺损非常大或缺损位于美容敏感区域的情况。
