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J Reconstr Microsurg 2023; 39(07): 565-572
DOI: 10.1055/a-2004-0196
Original Article

Outcomes and Perioperative Risk Factors after Oncologic Free-Flap Scalp Reconstruction

Jason W. Yu
1   Section of Oral & Maxillofacial Surgery, UCLA School of Dentistry, University of California Los Angeles, Los Angeles, California
,
Jacqueline J. Chu
2   Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
,
Philipp Franck
3   Division of Plastic Surgery, Department of Surgery, Weill Cornell Medicine, New York, New York
,
Thais O. Polanco
2   Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
,
Meghana G. Shamsunder
2   Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
,
Chad M. Teven
4   Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona
,
Joseph J. Disa
2   Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
,
Evan Matros
2   Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
,
Peter G. Cordeiro
2   Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
,
Babak J. Mehrara
2   Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
,
Jonas A. Nelson   *
2   Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
,
Robert J. Allen Jr.   *
2   Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York
› Author Affiliations Funding This research was funded in part through the NIH/NCI Cancer Center Support Grant, P30CA008748.
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Abstract

Background Little is known about the risk factors associated with complications after free flap scalp reconstruction. The purpose of this study was to identify patient, scalp defect, and flap characteristics associated with increased risk of surgical complications.

Methods A retrospective study was performed of free-flap scalp reconstruction in oncologic patients at Memorial Sloan Kettering Cancer Center from 2002 to 2017. Data collection included patient, defect, flap, and complication characteristics. Complications were classified into major, defined as complications requiring surgical intervention, and minor, defined as complications requiring conservative treatment. Risk factors and outcome variables were compared using chi-square with Fisher's exact test.

Results A total of 63 free flaps to the scalp in 58 patients were performed; average follow-up was 3.5 years. Most flaps were muscle-only or musculocutaneous. One-third of patients with free flaps experienced complications (n = 21, 15 major and 6 minor). Examining risk factors for complications, patients with cardiovascular disease were nearly three times more likely to have suffered a major complication than patients without cardiovascular disease (36.7 vs. 12.1%, p = 0.04). This was the only significant risk factor noted. Perioperative radiotherapy, prior scalp surgery, flap type, and recipient vessel selection were found to be nonsignificant risk factors.

Conclusion Cardiovascular disease may be a significant marker of risk for major complications in patients undergoing free-flap reconstruction of the scalp. This information should be used to help guide perioperative counseling and decision making in this challenging patient population.

Keywords

scalp reconstruction - free flap - perioperative risk - complications - cardiovascular disease

* Co-senior authorship.




Publication History

Received: 04 January 2022

Accepted: 30 November 2022

Accepted Manuscript online:
28 December 2022

Article published online:
31 January 2023

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