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Vol. 110. Issue 6.
Pages 474-481 (July - August 2019)
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Vol. 110. Issue 6.
Pages 474-481 (July - August 2019)
Original Article
DOI: 10.1016/j.adengl.2019.05.002
Reconstruction of Moderate-Sized Scalp Defects: A 1–2–3 Rule
Regla «1-2-3» para la reconstrucción de defectos de mediano tamaño del cuero cabelludo
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F. Russo
Servicio de Dermatología, Hospital Punta de Europa, Algeciras, Cádiz, Spain
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Abstract
Background and objective

Excision of cutaneous scalp tumors results in surgical defects that are difficult to repair because of poor distensibility in this area of the body. The main aim of this study was to develop a structured algorithm to help choose the best technique for reconstructing scalp defects.

Material and methods

Retrospective study of patients who required surgical reconstruction following excision of a cutaneous scalp tumor. We excluded patients with defects that could be closed by simple direct suture and defects for which it was initially decided to use a skin graft or healing by secondary intention. The defects were classified into 5 groups according to the minimum distance between edges. The different reconstruction techniques used were evaluated in each group. The outcomes analyzed were complete defect closure, intraoperative and postoperative complications, and final aesthetic result.

Results

We included 119 patients (102 men and 17 women) with a mean age of 71 years (range, 32–93 years). Mean follow-up was 42 months (range, 6–120 months). Sixty-eight patients had a moderate-sized defect with a distance between edges of 1 to 4cm. Reconstructions started with relaxation incisions in 43 defects and resulted in the successful closure of 22 of them. Defects with a distance of 1 to 2cm required a single relaxation incision. Two incisions were required for defects with a distance of 2 to 3cm, while 3 incisions were required for those with a distance of 3 to 4cm. In the 21 cases in which relaxation incisions were insufficient to close the defect, the incisions were extended to mobilize the flap to achieve closure. Relaxation incisions alone were insufficient for closing defects with a distance greater than 4cm.

Conclusions

The 1-2-3 rule can help in choosing the best reconstruction technique for moderate-sized defects based on the principle that 1, 2, or 3 initial relaxation incisions are needed depending on the minimum distance between edges (1-2cm, 2-3cm, or 3-4cm). In all cases, incision extension to mobilize the corresponding flaps remains an option.

Keywords:
Scalp surgery
Algorithm
Flaps
Resumen
Antecedentes y objetivos

La extirpación quirúrgica de tumores cutáneos de cuero cabelludo crea defectos difíciles de reparar por la poca distensibilidad de la zona. El objetivo principal de este trabajo es conseguir un algoritmo estructurado que permita la elección de la mejor técnica reconstructiva para el cierre de los defectos quirúrgicos de cuero cabelludo.

Materiales y métodos

Estudio retrospectivo de 119 pacientes que requirieron la extirpación quirúrgica de tumores de cuero cabelludo con posterior reconstrucción quirúrgica para el cierre del defecto. Se excluyeron los pacientes con defectos que pudieron ser cerrados mediante sutura directa simple, así como en los que desde el principio se decidió emplear injertos cutáneos o se dejaron cerrar por segunda intención. Los defectos se clasificaron en 5 grupos según la distancia mínima de aproximación de los bordes y se evaluaron en cada grupo las diferentes opciones de reconstrucción quirúrgica. Se tuvieron en cuenta como objetivos finales el cierre completo del defecto, las complicaciones intra- y postoperatorias, así como el resultado estético final.

Resultados

Se incluyeron 119 pacientes (102 varones y 17 mujeres); edad media 71 años (rango, 32-93 años). El seguimiento medio fue de 42 meses (rango, 6-120 meses). De los 119 pacientes, 68 tenían defectos de mediano tamaño con una distancia de aproximación entre 1 y 4cm. En 43 de ellos se inició la reconstrucción mediante incisiones de descarga que permitieron el cierre del defecto en 22 casos. Los defectos con distancias de 1 a 2cm necesitaron una sola incisión de descarga. Los comprendidos entre 2 y 3cm, 2 incisiones y de 3 a 4cm, 3 incisiones. En los 21 casos que no cerraron a través de las incisiones de descarga, se ampliaron estas incisiones a sus correspondientes colgajos para conseguir el cierre. Ninguno de los defectos mayores de 4cm cerró solo con las incisiones de descarga.

Conclusiones

La regla«1-2-3» permite elegir la mejor técnica reconstructiva para defectos de mediano tamaño realizando inicialmente 1, 2 o 3 incisiones de descarga según sea la distancia de aproximación de los bordes del defecto entre 1-2cm, entre 2-3cm o entre 3-4cm respectivamente, con la opción de ampliar a los colgajos correspondientes si fuera necesario.

Palabras clave:
Cirugía cuero cabelludo
Algoritmo
Colgajos

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