Versatility of Bipedicle Flap for Reconstruction of Large Scalp Defects
Background: Reconstruction of Scalp defects is a challenging problem. The unique hair bearing characteristics of scalp impose unique reconstructive challenges for coverage of scalp defects. Size, location and depth of the defect determine the complexity of the procedure. Patients with large scalp defects require reconstruction with broad based large scalp flaps. Objective: To determine the outcome of use of bipedicle scalp flap for coverage of large scalp defects. Study Design: Prospective & Observational study. Settings: Department of Plastic Surgery, Lahore General Hospital and Jinnah Burn & Reconstructive Surgery Centre Lahore-Pakistan. Duration: March 2010 to February 2019. Methodology: Eighteen patients of both genders with scalp defects secondary to trauma, tumor excision and burn injury were operated. Defect size more than 25cm2 were included in the study. Those patients in which residual scalp tissue was traumatized or inadequate for scalp reconstruction were excluded from the study. The variables and outcome measures included size, location of defect, flap survival and donor site complications. Bipedicle flaps designed in different axis depending on location and size of the defect. Results: Out of 18 patients included in this study, 12(66.67%) were male and 6 (33.3%) female. Age ranged from 32 to 78years (mean 48.66). Size of the defect ranged from 5.2x10.4cm to 18x14cm. Postoperatively 14(77%) flaps survived completely while marginal flap necrosis and dehiscence seen in 2(11%) patients. Hospital stay on average was 11 days. Recovery was quick in all patients and wound healing was satisfactory. The mean follow up period was 8 months. Minor complications like hematoma seen in 1(5%) patient. In 3 (16%) patients there was partial graft loss at flap donor site that healed with conservative management. Conclusion: Bipedicle flap provides healthy, durable and hair bearing tissue with good cosmetic outcome. Large defects can be reconstructed with a simple technique.