Surgical management of radiated scalp in patients with recurrent glioma.

by S Nair, G Giannakopoulos, M Granick, M Solomon, T McCormack, P Black
Neurosurgery ()


Patients with malignant brain tumors requiring multiple craniotomies\nand external beam radiotherapy are at risk of scalp wound breakdown\nsecondary to fibrosis and radiation damage. We present three cases\nto illustrate the nature of the problem and the surgical approaches\nto scalp repair. When a bicoronal incision has been used for the\ninitial craniotomy, the plastic repair can be performed with a bipedicle\nvisor scalp flap and split-thickness skin graft to cover the pericranium\nat the donor site. When a curvilinear (U-shaped or horseshoe) flap\nhas been used for the initial craniotomy, a single-pedicle flap may\nbe rotated to achieve closure without tension. In anticipation of\nthe risk of scalp wound breakdown in patients with malignant brain\ntumors, the planning of the operative incision for the first craniotomy\nneeds to take into account the long-term viability of the scalp.\nWe recommend linear scalp incisions parallel to the arterial distribution\ninstead of the traditional curvilinear (U-shaped or horseshoe) flaps;\nlinear incisions are less likely to break down, and in the event\nof breakdown, linear wounds offer better therapeutic surgical options\nfor plastic repair.

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