Evaluation Of Different Surgical Modalities For Reconstruction Of Skull And Scalp Deffects

In this thesis, the anatomy of the scalp and skull, causes of defects in each, reconstruction of simple scalp defects, simple skull defects and composite scalp and skull defects were reviewed. In addition, twenty patients with scalp and skull defects were reconstructed using different surgical modalities. The patients were categorized into 3 groups.Group A (7 cases): with simple scalp defects. Two of them were covered with split- thickness skin grafts. Three were reconstructed by local scalp flaps with grafting of the donor site and two cases with refractory scalp defects were reconstructed by free latissimus dorsi flaps and skin grafts.Group B (7 cases): with simple skull defects. Two of them were repaired using acrylic, one by split-rib graft and. four cases were reconstructed by outer table calvarial bone graft fixed to the cranium by titanium plates and screws.Group C (6 cases): with composite scalp and skull defects. In two of them, reconstruction of both the scalp and skull was performed and in four cases, reconstruction of the scalp only was performed. The results show that simple scalp defects with intact pericranium can be covered with split thickness skin grafts with satisfactory outcome. Scalp defects with abseGt pericranium up to 105 cm2 can be reconstructed using local scalp flaps with grafting of the donor site. Large scalp defects or refractory wounds can be reconstructed by free flaps with satisfactory results. Simple skull defects can be reconstructed either by acrylic or bone grafts. Two cases were repaired by acrylic with satisfactory results. One patient was repaired bysplit-rib with partial resorption of the graft noticed 6 months later by clinical and radiological follow up. Four cases were reconstructed using outer table calvarial bone graft fixed by titanium plates and screws with satisfactory outcome.In two cases with composite skull and scalp defects, both the scalp and skull were reconstructed with good functional and aesthetic results. In four cases with composite defects, the scalp defects only were reconstructed.The results were discussed and it was concluded that a split thickness skin graft could be used to cover scalp defects with intact pericranium. Local scalp flaps with skin grafts can be used in scalp defects up to 105 cm2. Distant or free flaps should be used to reconstruct large and refractory scalp defects. Simple skull defects can be reconstructed by acrylic or bone grafts. Calvarial bone grafts are preferable but acrylic should be used in very large defects or in the difficult fronto-orbital regions. In composite defects, the primary consideration is to replace the missing skin and if the conditions are convenient simultaneous cranioplasty can be performed.