The Experts below are selected from a list of 1653 Experts worldwide ranked by ideXlab platform
Babak J Mehrara - One of the best experts on this subject based on the ideXlab platform.
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Superficial temporal recipient vessels in microvascular orbit and Scalp Reconstruction of oncologic defects.
Journal of Reconstructive Microsurgery, 2009Co-Authors: Eric G. Halvorson, Peter G. Cordeiro, Joseph J Disa, Elizabeth F Wallin, Babak J MehraraAbstract:The superficial temporal artery and vein (STA/V) are often considered suboptimal recipient vessels due to anecdotal reports that they are unreliable and prone to spasm. This is unfortunate, as their position greatly facilitates Reconstruction of the Scalp and orbit. We present our experience with 28 patients who underwent microvascular craniofacial Reconstruction of oncological defects using the STA/V as recipients over a 4-year period at a single institution. Rates of vessel thrombosis, total flap loss, and partial flap loss were not significantly different from 282 flaps anastomosed to neck vessels. With knowledge of the anatomy and proper technique, the STA/V are reliable and available in most patients and can facilitate microvascular orbit and Scalp Reconstruction. The proximity they offer allows more flexibility in flap pedicle length requirement and avoids the use of vein grafts. Caution should be exercised if there is a history of radiation therapy.
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Scalp Reconstruction.
Journal of surgical oncology, 2006Co-Authors: Babak J Mehrara, Joseph J Disa, Andrea PusicAbstract:Scalp Reconstruction after oncologic resection can be challenging. Wide surgical resections, in combination with co-morbid conditions such as infected alloplastic material, cerebrospinal fluid (CSF) leak, or devascularized bone after craniotomy necessitate healthy, vascularized tissues for Reconstruction. Although primary closure is feasible in some cases, the mainstay of treatment involves local tissue rearrangement with or without split thickness skin grafting. In addition, free tissue transfer is an important adjunct to therapy in patients with poor local tissues. Careful analysis of the defect and local tissues can help tailor the method of Reconstruction and result in satisfactory closure in a majority of patients. Current techniques used for Scalp Reconstruction after surgical ablation are the subject of this review.
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Scalp Reconstruction: a 15-year experience.
Annals of plastic surgery, 2004Co-Authors: Martin I. Newman, Joseph J Disa, Matthew M. Hanasono, Peter G. Cordeiro, Babak J MehraraAbstract:Scalp Reconstruction after ablative surgery can be challenging. A useful reconstructive algorithm is lacking. The purpose of this study was to evaluate the authors' experience and to identify an appropriate reconstructive strategy. This was a retrospective review of all patients treated by the authors' service for Scalp defects during a 15-year period. Reconstructive methods, independent factors, and outcomes were analyzed. A total of 73 procedures were performed in 64 patients. Techniques for Reconstruction included primary closure, grafts, and local and distal flaps. A correlation between reconstructive technique and complications could not be demonstrated. However, an increased incidence of complications was correlated with a history of radiation, chemotherapy, cerebrospinal fluid leaks, and an anterior location of the ablative defect (P < 0.05). Important tenets for successful management of Scalp defects are durable coverage, adequate debridement, preservation of blood supply, and proper wound drainage. Local Scalp flaps with skin grafts, and free tissue transfer remain the mainstay of Reconstruction in most instances.
Eric J. Moore - One of the best experts on this subject based on the ideXlab platform.
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complications after oncologic Scalp Reconstruction a 139 patient series and treatment algorithm
Laryngoscope, 2015Co-Authors: Jeffrey R. Janus, Nicole M. Tombers, Brandon W. Peck, Daniel L. Price, Eric J. MooreAbstract: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. χ2 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. Level of Evidence 4 Laryngoscope, 125:582–588, 2015
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Complications after oncologic Scalp Reconstruction: A 139‐patient series and treatment algorithm
The Laryngoscope, 2014Co-Authors: Jeffrey R. Janus, Nicole M. Tombers, Brandon W. Peck, Daniel L. Price, Eric J. MooreAbstract: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. χ2 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. Level of Evidence 4 Laryngoscope, 125:582–588, 2015
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An Evidence-Based Approach to Oncologic Scalp Reconstruction
Otolaryngology–Head and Neck Surgery, 2013Co-Authors: Jeffrey R. Janus, A. Mirzoyev, Nicole M. Tombers, Eric J. MooreAbstract:Objectives:Describe an algorithm for oncologic Scalp Reconstruction based on a single institution’s surgical experience and analysis of outcomes.Methods:This is a single institution, retrospective review of patients requiring oncologic Scalp ablation with subsequent Reconstruction from 1992-2012. Demographics include patient age, sex, immunosuppressive state, and type of malignancy. Measured endpoints include defect size/location/depth, the Reconstruction method used, concomitant surgery (ie lymphadenectomy), adjunctive chemotherapy or radiotherapy, complication rate, and length of follow-up.Results:A total of 140 patients are reviewed with an average age of 70.4 years; 76% being male. Approximately 51% of all patients required postoperative radiation, chemotherapy, or both. Defect widths range from 0.7cm to 24cm, with an average of 7.5cm. Depths range from full-thickness skin to full-thickness skull, the majority being up to pericranium (30%). Reconstruction varies from simple granulation to free tissue ...
Eduardo D Rodriguez - One of the best experts on this subject based on the ideXlab platform.
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Microsurgical Scalp Reconstruction in the elderly: a systematic review and pooled analysis of the current data.
Plastic and reconstructive surgery, 2015Co-Authors: Michael Sosin, Benjamin D Schultz, Carla De La Cruz, Edward R Hammond, Michael R Christy, Branko Bojovic, Eduardo D RodriguezAbstract:Microvascular Reconstruction is the mainstay of treatment in complex Scalp defects. The rate of elderly patients requiring Scalp Reconstruction is increasing, but outcomes in elderly patients are unclear. The purpose of this study was to systematically review the literature pertaining to free tissue transfer for Scalp Reconstruction in patients older than 65 years to compare outcomes among different free flaps and determine the safety profile of treatment. A systematic review of the available literature of patients undergoing microvascular Scalp Reconstruction was completed. Details for patients 65 years and older were extracted and reviewed for data analysis. A total of 45 articles (112 patients) were included for analysis. Mean age of the patients was 73.3 ± 6.3 years (men, 69.4 percent; women, 23.4 percent; not reported, 7.2 percent). Mean flap size was 598 cm2 (range, 81 to 2500 cm2). The mean age of patients developing a complication was 72.8 ± 6.4 years and patients that did not develop a complication was 73.4 ± 5.5 years (p = 0.684). Overall, periprocedural mortality was 0.9 percent. Flap failures occurred in two cases (1.8 percent). The overall complication rate was 22.3 percent (n = 25). Complications by flap type varied without reaching statistical significance. Microvascular Reconstruction in complex Scalp defects is associated with successful outcomes, and chronologic age does not increase mortality or catastrophic flap complications. The most common flaps used to repair Scalp defects are anterolateral thigh and latissimus dorsi, but a superior flap type could not be identified.
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Lessons Learned in Scalp Reconstruction and Tailoring Free Tissue Transfer in the Elderly: A Case Series and Literature Review.
Craniomaxillofacial trauma & reconstruction, 2014Co-Authors: Michael Sosin, Carla De La Cruz, Branko Bojovic, Arif Chaudhry, Paul N. Manson, Eduardo D RodriguezAbstract:This article aims to demonstrate an individualized approach to an elderly patient requiring Scalp Reconstruction, to describe the methodology in flap selection, lessons learned, and report outcomes. A retrospective review of a single surgeon's experience of Scalp Reconstruction (E. D. R.) using free tissue transfer from 2005 to 2011, in patients older than 70 years, was completed. A total of eight patients met the inclusion criteria, five males and three females, with a mean age of 80.4 years (range, 73–92). Free tissue transfer achieved 100% soft tissue coverage. Six of the eight patients required cranioplasty. The mean size calvarial defect was 92 cm 2 (range, 35–285 cm 2 ). The mean flap size was 117.6 cm 2 (range, 42–285 cm 2 ). Free flaps included three ulnar, three anterolateral thigh, one latissimus dorsi, and one thoracodorsal perforator flap. The mean follow-up time was 18.4 months (range, 3–46 months). Donor site morbidity was minimal. Mortality was 0%. Immediate flap failure was 0%. Other complications occurred in six of the eight patients. Mean revisionary procedures were 1.25 procedures per patient. It was concluded that chronological age does not increase mortality or catastrophic flap complications; however, morbidity is increased in the elderly and revisionary surgery is likely.
Joseph J Disa - One of the best experts on this subject based on the ideXlab platform.
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Scalp Reconstruction
Operative Plastic Surgery, 2019Co-Authors: Joseph J Disa, Edward RayAbstract:The Scalp serves both protective and aesthetic functions. Injury or loss of the Scalp may lead to desiccation and osteonecrosis of the underlying calvarium as well as potentially life-threatening osteomyelitis and meningitis. Reconstruction of the Scalp starts with a systematic approach, beginning with definition of the defect, identification of the reconstructive priorities, and a thorough assessment of the patient’s anatomy and history. Comorbidities, history of radiation or prior Reconstruction, physical condition, and patient compliance are important factors to consider as well. Depending on each of these considerations, options available to the reconstructive surgeon include single- and multiple-stage procedures, grafts, local/regional flaps, and free tissue transfer.
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Superficial temporal recipient vessels in microvascular orbit and Scalp Reconstruction of oncologic defects.
Journal of Reconstructive Microsurgery, 2009Co-Authors: Eric G. Halvorson, Peter G. Cordeiro, Joseph J Disa, Elizabeth F Wallin, Babak J MehraraAbstract:The superficial temporal artery and vein (STA/V) are often considered suboptimal recipient vessels due to anecdotal reports that they are unreliable and prone to spasm. This is unfortunate, as their position greatly facilitates Reconstruction of the Scalp and orbit. We present our experience with 28 patients who underwent microvascular craniofacial Reconstruction of oncological defects using the STA/V as recipients over a 4-year period at a single institution. Rates of vessel thrombosis, total flap loss, and partial flap loss were not significantly different from 282 flaps anastomosed to neck vessels. With knowledge of the anatomy and proper technique, the STA/V are reliable and available in most patients and can facilitate microvascular orbit and Scalp Reconstruction. The proximity they offer allows more flexibility in flap pedicle length requirement and avoids the use of vein grafts. Caution should be exercised if there is a history of radiation therapy.
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Scalp Reconstruction.
Journal of surgical oncology, 2006Co-Authors: Babak J Mehrara, Joseph J Disa, Andrea PusicAbstract:Scalp Reconstruction after oncologic resection can be challenging. Wide surgical resections, in combination with co-morbid conditions such as infected alloplastic material, cerebrospinal fluid (CSF) leak, or devascularized bone after craniotomy necessitate healthy, vascularized tissues for Reconstruction. Although primary closure is feasible in some cases, the mainstay of treatment involves local tissue rearrangement with or without split thickness skin grafting. In addition, free tissue transfer is an important adjunct to therapy in patients with poor local tissues. Careful analysis of the defect and local tissues can help tailor the method of Reconstruction and result in satisfactory closure in a majority of patients. Current techniques used for Scalp Reconstruction after surgical ablation are the subject of this review.
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Scalp Reconstruction: a 15-year experience.
Annals of plastic surgery, 2004Co-Authors: Martin I. Newman, Joseph J Disa, Matthew M. Hanasono, Peter G. Cordeiro, Babak J MehraraAbstract:Scalp Reconstruction after ablative surgery can be challenging. A useful reconstructive algorithm is lacking. The purpose of this study was to evaluate the authors' experience and to identify an appropriate reconstructive strategy. This was a retrospective review of all patients treated by the authors' service for Scalp defects during a 15-year period. Reconstructive methods, independent factors, and outcomes were analyzed. A total of 73 procedures were performed in 64 patients. Techniques for Reconstruction included primary closure, grafts, and local and distal flaps. A correlation between reconstructive technique and complications could not be demonstrated. However, an increased incidence of complications was correlated with a history of radiation, chemotherapy, cerebrospinal fluid leaks, and an anterior location of the ablative defect (P < 0.05). Important tenets for successful management of Scalp defects are durable coverage, adequate debridement, preservation of blood supply, and proper wound drainage. Local Scalp flaps with skin grafts, and free tissue transfer remain the mainstay of Reconstruction in most instances.
Charles Baillieu - One of the best experts on this subject based on the ideXlab platform.
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Total Scalp Reconstruction with bilateral anterolateral thigh flaps
Microsurgery, 2012Co-Authors: Melissa M. Kwee, Warren M. Rozen, Jeannette W.c. Ting, Mansoor Mirkazemi, James Leong, Charles BaillieuAbstract:Large Scalp defects can require complicated options for Reconstruction, often only achieved with free flaps. In some cases, even a single free flap may not suffice. We review the literature for options in the coverage of all reported large Scalp defects, and report a unique case in which total Scalp Reconstruction was required. In this case, two anterolateral thigh (ALT) flaps were used to resurface a large Scalp and defect, covering a total of 743 cm(2). The defect occurred after resection and radiotherapy for desmoplastic melanoma, with several failed skin grafts and local flaps and osteoradionecrosis involving both inner and outer tables of the skull. The Reconstruction was achieved as a single-stage Reconstruction and involved wide resection of cranium and overlying soft-tissues and Reconstruction with calcium phosphate bone graft substitute, titanium mesh, and two large ALT flaps. The Reconstruction was successfully achieved, with minor postoperative complications including tip necrosis of one of the flaps and wound breakdown at one of the donor sites. This is the first reported case of two large ALT flaps for Scalp resurfacing and may be the largest reported Scalp defect to be completely resurfaced by free flaps. The use of bilateral ALT flaps can be a viable option for the Reconstruction of large and/or complicated Scalp defects.
