Management
Free flap reconstruction, including the radial forearm free flap, is highlighted as a desirable and versatile therapy for extensive scalp defects resulting from surgical resection of cutaneous malignancies [PMID:22583845].
Advantages of using the radial forearm free flap include the convenience of harvesting without patient repositioning and shorter operative times, making it particularly suitable for complex scalp reconstructions [PMID:22583845].
A systematic review including 112 patients older than 65 years undergoing microvascular scalp reconstruction revealed an overall complication rate of 22.3% and a periprocedural mortality rate of 0.9% [PMID:25719702].
For defects that cannot be closed primarily, rotation flaps developed within the subgaleal space are often the best reconstruction option [PMID:15620616].
In contrast to other areas, scalp wounds are closed under significant tension because the galea restricts overlying tissue movement [PMID:15620616].
Complications
The effectiveness of microvascular free flap techniques, including the radial forearm flap, is contingent upon factors such as donor site morbidity, indicating it as a consideration in management decisions [PMID:22583845].
Among the reviewed elderly patients, the overall complication rate was 22.3%, with flap failures occurring in only 1.8% of cases [PMID:25719702].
The significant tension required for closing scalp wounds can pose challenges and potentially lead to complications [PMID:15620616].
Prognosis & Follow-up
The study found no significant difference in mortality or catastrophic flap failure between elderly patients who developed complications and those who did not, with p-values indicating no statistical significance [PMID:25719702].
References
1 Sweeny L, Eby B, Magnuson JS, Carroll WR, Rosenthal EL. Reconstruction of scalp defects with the radial forearm free flap. Head & neck oncology 2012. link 2 Sosin M, Schultz BD, De La Cruz C, Hammond ER, Christy MR, Bojovic B et al.. Microsurgical scalp reconstruction in the elderly: a systematic review and pooled analysis of the current data. Plastic and reconstructive surgery 2015. link 3 Seline PC, Siegle RJ. Scalp reconstruction. Dermatologic clinics 2005. link