Bast F1, Chadha P2, Jakharia-Shah N3* and Collier J4
1Department for Otorhinolaryngology, AMEOS Klinikum Haldensleben, Haldensleben, Germany
2Department of Plastic Surgery, St Thomas’ Hospital, UK
3King’s College London, School of Medicine, London, UK
4Chelsea and Westminster Hospital, Craniofacial Unit, London, UK
Introduction: Large cutaneous defects of the forehead and scalp, which can extend down to the bone, often present significant reconstructive challenges. In some patients, lack of local tissue elasticity in these areas precludes closure with simple flaps, while multi-stage tissue expansion or free tissue transfer may be limited by patient age and co-morbidities. Grafting onto bare bone must be preceded by procedures to stimulate granulation tissue, usually by drilling of the outer table. Wound healing is a long-term process requiring multiple dressing changes and the cosmetic result is often considered to be suboptimal. Vacuum assisted wound closure is well established in the management of complex or chronic wounds. However, its use for full thickness grafting on the scalp has not been well described. The aim of this article is to describe our experience with this technique and explore our perceived advantages and disadvantages of this method. Material and
Methods: We retrospectively analysed two patients with large skin defects on the forehead and scalp, created after full clearance of Basal Cell Carcinomas (BCC). All wounds were successfully closed after excision through the use of vacuum assisted closure (VAC) devices. Clinical assessments of the wounds were undertaken on a regular basis to assess progress.
Results: After 3 weeks of VAC dressing changes, undertaken in the outpatient department, the entire wound of both patients contained viable granulation tissue. Closure using a full-thickness skin graft was undertaken successfully. The VAC system was applied again at the end of the surgery and removed one week postoperatively. No wound healing problems occurred. 7 weeks after the initial BCC excision, all wounds were completely closed, the scalps were covered with viable skin grafts and the aesthetic results were deemed very satisfactory by the patients themselves.
Discussion: The VAC system can be used for the treatment of larger defects in the scalp area, where direct closure can often be problematic for a variety of reasons. In our experience, it is easy to use and well tolerated by patients. Wound healing can be expedited with minimal morbidity and the technique can also be cost effective.
Negative-pressure; Wound closure; Wound treatment; Vacuum suction devices; Scalp defects; Vacuum assisted wound closure
Bast F, Chadha P, Jakharia-Shah N, Collier J. Treatment of Large Cutaneous Defects of the Scalp by Vacuum- Assisted Wound Dressing. Ann Clin Otolaryngol. 2017; 2(3): 1020.