Risk Factors for Wound Complications of Local Flap Reconstruction of the Scalp

Introduction: Local flaps are used for scalp reconstruction due to their minimal morbidity, skin color match, and ability to preserve hair, but their outcomes can be difficult to predict. The objective of this study was to assess the pre-operative and operative variables associated with wound complications of scalp defects reconstructed with local flaps.

Methods: This case-control study evaluated consecutive patients from 1/2019-8/2024 undergoing local flap reconstruction of the scalp following cutaneous malignancy resection. The primary outcome measure was the composite presence of infection, necrosis, and/or dehiscence of the surgical site, which defined the cases. Univariate binomial logistic regression was used to calculate the odds ratio (OR) for each predictor variable. A multivariate regression model was used to determine the adjusted odds ratio (aOR) of the predictor variables.

Results: A total of 110 patients comprising 74% males (n=81) underwent scalp reconstruction with local flaps with a median (min-max) age of 75 years (26-94). The most common local flaps were the snail (n = 49, 45%), hatchet (n = 21, 19%), and bilobed (n = 15, 14%) flaps used to reconstruct a mean (SD) defect diameter of 5.5 cm (2.0 cm). Forty-two (38%) patients experienced any wound complication. The multivariate model included moderate-to-severe comorbidity status [aOR 5.1 (1.9-13.4)], age [aOR 0.96 (0.92-0.99)], non-melanoma histopathology [aOR 3.3 (0.88-12.3)], former smoking status [aOR 1.7 (0.64-4.2)], and active smoking status [aOR 8.3 (1.2-57.7)]. Important variables not associated with wound complications were diabetes mellitus, immunosuppression, type of local flap used, preservation of hair in the operative field, and suture type.

Conclusions: Moderate-to-severe comorbidity status and active smoking are the two most important predictors associated with wound complications following local flap reconstruction of the scalp. Isolated comorbidities and intra-operative decisions, such as suture type, may not play as critical of a role in determining the risk of wound complications.