Aesthetic and Oncologic Outcome after Microsurgical Reconstruction of Complex Scalp and Forehead Defects after Malignant Tumor Resection: An Algorithm for Treatment

Background: Limited follow-up data on aesthetic outcome and survival after microsurgical reconstruction of complex scalp and forehead defects are available. These data are important to improve reconstruction quality and patient counseling. The purpose of this study was to evaluate surgical, aesthetic, and oncologic outcome of free flap scalp and forehead reconstructions in the patient population of two academic centers. Methods: Retrospective data analysis of patients with a microsurgical reconstruction of the scalp or forehead between January of 1999 and June of 2008 was performed. Aesthetic outcome was assessed on a five-point Likert scale for flap color match, contour, and overall aesthetic result. Results: The group consisted of 84 patients with a mean follow-up time of 27 months (range, 1 to 95 months). Mean defect size was 134 cm(2) (range, 20 to 340 cm2), with 46 percent full-thickness bone defects and 16 percent dura defects. The most commonly used free flaps were latissimus dorsi (n = 34) and anterolateral thigh (n = 24). Total flap failure occurred in five patients (6 percent). Disease-free survival and overall survival rates at 5 years were 57 and 65 percent, respectively. Additional operations for aesthetic reasons were performed in 19 patients (23 percent). Panel scores showed a significant lower satisfaction with reconstruction of defects that were located over the frontal scalp compared with other locations (p = 0.004). Conclusions: Microsurgical reconstruction in complex scalp and forehead defects is a safe procedure. From the authors' experience, they suggest an algorithm for reconstruction of these complex reconstructive defects that will most likely result in the best aesthetic result. (Plast. Reconstr. Surg 126: 460, 2010.