Occipital artery Island V–Y advancement flap for reconstruction of posterior scalp defects

Summary 

Background

The management of the posterior scalp defects with ‘similar’ tissue can be challenging. Currently available techniques of transposition/rotation result in creation of unwanted dog ears, change in direction of hairs and patches of skin-grafted areas with alopecia. We describe a new method of reconstruction of full-thickness scalp defects in the occipital region by moving the locally available scalp tissue in a V–Y advancement manner. The islanded flap is based upon the ipsilateral occipital artery in the substance of occipitalis muscle. The donor site/s can be closed primarily and the operation performed in a single stage

Materials and methods

A total of seven patients have undergone reconstruction in the last 2 years with this technique. The defects in the posterior scalp region resulted either from the electrical burns (two patients), tumour excision (two patients), encephalocoele excision (one patient) or post-traumatic loss of the scalp (two patients). In all the patients the underlying bone was exposed. The remaining scalp tissue in the vicinity of the defect was moved as a V–Y advancement flap either unilaterally or bilaterally depending upon the size of the defect. The pedicle of the flaps contained ipsilateral occipital vessels at the base. The flaps were raised in the subgaleal plane and the pedicle included ipsilateral occipital artery in the substance of the occipitalis muscle.

Results

The donor area could be closed primarily in all cases. All the flaps survived completely; one patient had postoperative superficial loss that eventually healed with dressings. All the wounds healed primarily with luxuriant hair growth, except one patient who had partial alopecia in the transferred flap although the flap survived completely.

Conclusion

The islanded occipital artery V–Y advancement flap provides a one-stage hair-bearing scalp tissue for closure of medium and moderately large defects (up to 7×6.5cm²) in the posterior region of the scalp with primary closure of the donor site.

Keywords: Scalp defects, Occipital region, Occipital island flap, V–Y advancement, Primary closure, Direction of hair