Complications after oncologic scalp reconstruction: a 139-patient series and treatment algorithm.

OBJECTIVES/HYPOTHESIS: Evaluate the factors influencing choice of technique and complications of scalp reconstruction after oncologic ablation.

STUDY DESIGN: A single-institution retrospective review of 139 patients requiring oncologic scalp resection with subsequent reconstruction from 1992 to 2010 was completed.

METHODS: The type of reconstruction used and complications encountered postoperatively were recorded over a mean follow-up of 2.4 years. χ(2) and Fisher exact tests were used to compare complication rates based on defect characteristics, type of reconstruction, and patient demographics and comorbidities.

RESULTS: Defect widths ranged from 0.7 to 35 cm of varying depths. Closure methods ranged from partial closure with granulation to free tissue transfer. The overall complication rate was 10.8%. Complication rates were higher when dealing with larger defect sizes (P = .016), deeper defects (P = .004), in patients who received preoperative radiation (P = .026), and in patients who were immunosuppressed (P = .026).

CONCLUSIONS: Scalp defects encountered after oncologic resection can be a challenging reconstruction. The defect location, size, depth, and unique patient factors likely to affect wound healing should all be considered when choosing between reconstructive options. Larger and deeper defects and patient factors, such as preoperative radiation and immunosuppression, are more prone to wound complications and may require more advanced reconstructive techniques such as pedicled locoregional flaps or free tissue transfer. An algorithm for scalp reconstruction based on these principles is provided.