Scalp Reconstruction following Excision of Malignant Tumors in Southeastern Nigeria

Abstract

Background: Malignant scalp tumors are not common and constitute a small percentage of all scalp tumors. Reconstruction of the scalp defects following oncological resection presents peculiar challenges. Aim: The aim of the study is to report our experience in reconstructing scalp defect of varying sizes after the excision of malignant tumours using a variety of techniques. Materials and Methods: This was a retrospective review of patients who had scalp reconstruction after oncological resections from June 2010 to May 2014 (four years) at our teaching hospital in the South‑east of Nigeria. Data on the demographics, nature of the scalp tumors, site, size of the defects, mode of scalp reconstruction, and outcomes were collected and analyzed. Results: Of the 17 patients who had scalp reconstruction, 29.4% of them were men and 70.6% were women (M:F = 5:2). The mean age of the patients was 41.2 ± 4.98 years (range: 19–85 years). The majority of the patients (47.1%) were young adults between 20 and 40 years, and the least involved age group (11.8%) was 13–19 years. The most common etiology of malignant scalp tumors was squamous cell carcinoma (52.9%). The temporal region was the most common site (41.2%) affected. Most of the defects were between 6.1 and 9.0 cm in diameter, followed by defects that were <3 cm in diameter. Neurosurgical assistance was required in 5 (29.4%) patients where the tumor had involved the skull bone. Tumor recurrence was noted in 3 (17.6%) patients within one year of follow‑up. Conclusion: Scalp reconstruction after oncological resection presents a peculiar esthetic challenge due to the hair‑bearing skin of the scalp and the need to maintain the hairline. The use of local flaps from the scalp remains the first and the best option. For very large scalp defects, free flap through microvascular surgery is the preferred option.