Anterolateral thigh adipofascial flap combined with skin paddle in three-dimension scalp reconstruction: A case report

Abstract

Introduction and importance

Management of cranial and scalp defects is always challenging. Complication rates following cranioplasty are still high (10–40 %), including bone graft resorption, infection, and T-mesh implant exposure due to thinning of soft tissue (Yeap et al., 2019; Alkhaibary et al., 2020; Cho and Kang, 2017 [1–3]).

Case presentation

We present a case of a 38-year-old male with autologous bone graft resorption accompanied by thinning of the forehead skin. He underwent cranioplasty with titanium mesh (T-mesh) and scalp reconstruction with an anterolateral thigh (ALT) flap in a single-stage operation. A 2-component ALT flap was used: the skin paddle covered the scalp defect to reduce closure tension, and especially the adipofascial flap lining beneath the forehead skin to increase thickness. Postoperative results were great in terms of coverage function and aesthetics.

Clinical discussion

The phenomenon of soft tissue thinning causing titanium mesh exposure is a common complication with a rate of 10–14 % (Yeap et al., 2019; Dong et al., 2020; Maqbool et al., 2018 [1, 4, 5]). Using adipofascial ALT flap as a sub-scalp filler material has many advantages over the latissimus dorsi (LD) flap to increase scalp thickness but still ensure aesthetics.

Conclusion

The results suggest a new direction in using adipofascial ALT flap as filler material to increase scalp thickness to reduce T-mesh exposure following cranioplasty.

Highlights

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  Cranioplasty and scalp reconstruction in a single operation

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  2-component anterolateral thigh flap: adipofascial flap and fasciocutaneous flap

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  Adipofascial flap was inserted beneath forehead skin to increase scalp thickness.

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  Comparison between anterolateral thigh flap and latissimus dorsi flap