Secondary Reconstruction of Calvarial Defects by Using Free Flap: Report of Consecutive Cases and Analysis of Strategy

Introduction: Multiplication of incisions and/or radiotherapy on the scalp, lead to skin necrosis and chronic osteitis. In this situation, reconstructive surgery can be useful to cover complex lack of tissue. Materials and Methods: The 5 patients were treated with the neurosurgery department of our hospital. The procedure included debridement of the infected calvarian bone and tissues and coverage by free antebrachial flap. A 2 stages skin graft, using a dermal regeneration template, or direct closure was used for the donor site. Evaluation of flap quality and donor site morbidity was done during hospitalization and 3 months after the procedure. Results: The procedure was achieved on 5 patients. All the patients were healed 3 months after surgery. For 1 patient, a second procedure was done in emergency for anastomosis revision. There was non-complication concerning the donor site. All the patients healed with a good coverage. Conclusion: Treatment of calvarian bone necrosis needs a very good and reliable coverage, such as free flap can provide. In our opinion, the antebrachial free flap is an interesting option, despite the fact that it is still underused for scalp coverage. Address correspondence and reprint requests to Antoine Heron, MD, Resident in Plastic and Burn Surgery Department, FX Michelet Center, Bordeaux Hospital, Bordeaux University, Bordeaux, France; E-mail: antoine.heron@chu-bordeaux.fr Received 5 April, 2018 Accepted 1 September, 2018 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

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