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The Neuroplastic Approach to Composite Scalp and Skull Defects
Jillian Krebs, BS; Abigail Meyers, BS; Thomas Xia, BS; Sean Nagel, MD; Mark Bain, MD; Lilyana Angelov, MD; Varun Kshettry, MD; Antonio Rampazzo, MD, PhD; Bahar Bassiri Gharb, MD, PhD
Cleveland Clinic Foundation
2022-01-15
Presenter: Jillian Krebs
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. A majority of the study design and entirety of data collection, analysis, and writing in preparation of the abstract was carried out by the first two authors.
Director Name: Bahar Bassiri Gharb
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose
This study aimed to present outcomes of reconstruction of composite scalp and skull defects and to stratify risk factors for poor outcomes.
Methods
An IRB-approved retrospective review of patients who underwent scalp and/or calvarial reconstruction with a minimum of one year follow-up was conducted. Complications were divided into major and minor; early, intermediate, and late (≤30, >30 to ≤90, and >90 days). Univariate logistic regression was conducted to identify risk factors associated with occurrence of complications.
Results
One hundred seventy-one patients underwent 418 procedures. Average follow-up was 38.1±36.5 months and 57 patients (33%) were deceased (63% due to cancer). Procedures included 181 scalp flaps (43%), 86 free flaps (21%), 63 complex layered closures (15%), assistance with exposure in 23 cases (6%), and 21 simple closures (5%). Complications occurred following 48% of procedures; 92% were major. Frontal location of the defect was a risk factor for major complications (OR 1.59 (95% CI 1.06 - 2.39), p=0.026). Titanium hardware became exposed in 35.6% of cranioplasties, at a median of 4.3 [2.3-18.2] months postoperatively. A non-healing wound occurred in 23%, and infection in 9%.
The mortality rate for patients with malignant intracranial neoplasms was 68.4% (surviving 4.3 [1.9-8.4] months), 39.1% for scalp and skull neoplasms (7.0 [4.3-16.6] months), 37.5% for scalp neoplasms (16.0 [14.6-28.2] months), and 16.7% for benign meningiomas (28.2 [26.7-45.1] months).
Conclusion
Given high exposure rate of titanium hardware in oncologic patients shortly after reconstruction, alloplastic reconstruction is recommended only in patients with a prognosis estimated less than 6 months.
