Reconstruction of the Scalp, Forehead, Calvarium, Skull Base, and Midface Flashcards
How many regional flaps are in the calvarial?
only three regional flaps (pericranium, temporoparietal fascia, and temporalis muscle)
The blood supply of the forehead and scalp
supraorbital, supratrochlear, superficial temporal (ST),
posterior auricular, and occipital vessels.
The sensory nerves
the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, lesser occipital, and greater occipital
nerves.
defect up to 5 cam can closed primarly
F No greater than 3 cm in diameter
Techniques that can utilise to facilitates primary closure
First, the resection
can be designed so that the closure is oriented perpendicular to the
relaxed skin tension lines; this tends to be in a sagittal direction on
the scalp and in a transverse direction on the forehead. Second, wide
undermining in the subgaleal layer along the circumference of the
defect can reduce tension. Finally, galeal scoring is an adjunctive
technique that can increase scalp pliability and reduce closure tension.
Scores deeper than the galea will disrupt the random pattern
blood supply of the scalp
T
After burring the outer table the skin graft should put in delayed fashion
F This can be performed
immediately or with an intermediate stage using a dermal substitute
areas of the scalp with laxity
the parietal and temporal regions
What is the back grafting
Reconstruction of larger defects may require
elevating the local flap in the subgaleal plane and maintaining the
pericranium so that the donor site can then be closed with a skin graft
The draw back of the Orticochea flap?
unpopular because of the
high rate of partial flap necrosis
The aesthetic subunit principle
should be followed to make the reconstruction as inconspicuous as
possible. in forehead reconstruction
T
The most suitable donor site for skin graft to forhead
skin grafts should be harvested from a
location above the clavicles to achieve a good color match
Contraindications in using tissue expansion in forehead and scalp surgery
It is less germane in the oncologic setting when there is typically an urgent need for resection,
a history of radiation therapy or the anticipated need for adjuvant radiation precludes the use of tissue expansion,
tissue expansion provide hair-bearing tissue of a similar thickness
T
The temporoparietal fascia! flap and temporalis muscle flap can
be used for defects within or adjacent to the temporal area or lateral
forehead
T
Recipient vessels should have a similar caliber in free flap
T
the anastomosis should be
performed above the tragal notch where the vessels emerge
from the parotid.
F the anastomosis should be
performed at the level of the tragal notch where the vessels emerge
from the parotid.
pedicle length required to travel from the neck to the scalp almost
always necessitates the use ofa vein graft
T
age is not a contraindication
to microsurgical scalp reconstruction
T
The atrophy of the muscle flap will accelerate with radiotherapy
T
Flaps with a skin paddle may be preferred in situations where the flap is covering a cranioplasty.
T
Calvarial reconstruction is usually recommended for any full-thickness defect greater than 10 cm
F Calvarial reconstruction is usually recommended for any full-thickness defect greater than 6 cm
The type of alloplastic material used was not found to be
an independent risk factor for complications
T
What is the thickest bone in the skull ?
he parietal bone
The pariental graft site should not extend any
further medially than 2 cm lateral to midline
F 1.5
the extracranial
technique is usually performed by a neurosurgeon
T
larger defects can be
repaired using rib.
T 7TH & 8 TH
The maximum number of ribs that can be harvested?
more than two or three ribs
Vascularized bone flaps are useful for larger calvarial defects
F Vascularized bone flaps are useful for smaller calvarial defects
Options of vascularised free bone graft
chimeric latissimus-serratus anterior flap can be
designed with vascularized rib
chimeric scapular/parascapular flap has also been
described for this purpose, but with using a segment of scapula
free fibula flap has -specifically for
replacing the anterior table of the frontal sinus in the setting of a
chronic mucocele.
Radial forearm flap Similar thickness as native scalp
T
Omentum Usually atrophies significantly over time
T
Calcium phosphate as alloplastic is britle and used for small defect and high risk of infection
T
Muscle flap with skin reconstruction of the scalp need debulking later-on
T
The skin of the scalp is among the thickest in the body, measuring 3 to
8 mm
T
The scores should be designed in parallel with the leading edge
of the flap, be spaced no closer than 1 cm apart, and only divide the
galea in galea scoring
T
Each galeal incision increases the length
of the scalp 1.67 mm
T
skin graft and is not recommended as a long-term solution or in the context of radiation.
In any situation,
T
once healed, the graft will not bear hair. Additionally,
because of the difference in thickness between the native scalp and a
skin graft, a noticeable contour deformity will be present
T
Most local flaps are designed using the
rotation-advancement principle and should be oriented to recruit
tissue from areas of the scalp with laxity, such as the parietal and temporal regions.
T
healing by secondary intention can have a better cosmetic outcome than skin grafting, as can be frequently seen in the treatment of
donor defects for forehead flaps
T
The incision used to place the
expander should be designed in the area of scalp that will be excised
and should be oriented perpendicular to the axis of expansion to help
prevent incisional dehiscence and exposure of the device
T
In large
defects, multiple expanders can be placed; ports are typically remote.
T
The trapezius
muscle can be designed as either a muscle or myocutaneous flap and
can be used to reconstruct the occipital scalp
T
The superficial temporal artery tends to be more superficial and
posterior, whereas the vein may exist in a slightly deeper plane and
more anterior
T
If the ST vessels are not available or insufficient, the neck provides a multitude of options: facial, lingual, superior thyroid
T
The vein grafts should be placed beneath a widely undermined cutaneous tunnel, and the patient should be prevented
from wearing eyeglasses during the immediate postoperative period
to avoid compression
T
The incidence of cutaneous malignancies located on the scalp is higher in elderly patients and continues to rise after age 65 years.
T
Muscle flaps are bulky initially, but will atrophy
over time; this effect is accelerated if postoperative radiation is given
. Once the flap atrophies, it contours nicely along
the underlying skull.
T
Flaps with a skin paddle are thought to be more durable
and may be preferred in situations where the flap is covering a cranioplasty
T
The disadvantage to a skin paddle is that it may require a
secondary debulking procedure to improve the contour, as these flaps
are less likely to atrophy
T
Calvarial reconstruction is most commonly performed using
autologous reconstruction
F Calvarial reconstruction is most commonly performed using
alloplastic materials
Calvarial bone can be harvested using an
in situ technique or an extracranial approach
T
The advantage of in situ techniqueis that
it avoids accessing the intracranial space
T
Disadvantages include the
creation of a depression contour deformity along the skull; additionally, the size of the graft is limited
T
In the extracranial approach, a craniotomy is performed and a full-thickness section of the calvarium is
removed.
T
in men, rib graft is harvested through an incision directly over
the rib, whereas in women, an inframammary fold incision is better camouflaged.
T
Gaps between the rib grafts can be filled
with either particulate cadaveric allograft bone, calcium phosphate
bone cement, or hydroxyapatite putty
T
Serratus anterior can be used all muscle for MICROSURGICAL SCALP RECONSTRUCTION
F Only inferior 3 or 4 slips are harvested to prevent
winging of the scapula
Pedicle is on posterior surfase of the serratus muscle surface of the muscle; care must be
taken during exposure
F Pedicle is on anterior surface of the muscle; care must be
taken during exposure
Omentum flap has Variable skin graft take
T
infection is fortunately uncommon in the scalp and calvarium.
T
Calcium phosphate Brittle Use limited to smaller defects
T
