(0623) Complications From Microsurgical Repair of Scalp and Calvarial Defects: A Systematic Review and Meta-analysis

Introduction: Scalp and calvarial defects remain a common reconstructive challenge and are usually repaired with free tissue transfer. Complications are common and can have devastating consequences due to inadequate protection of the brain. There is a paucity of data to guide surgeons on the best way to reconstruct these difficult defects. Our aim was to systematically review the literature and identify the patient risk factors and reconstructive choices that are associated with complications.

Methods: Using the preferred reporting items for systematic reviews and meta-analysis statement standards, a systematic review was conducted for studies that reported outcomes after free flap reconstruction for scalp and calvarial defects. A meta-analysis was then performed comparing rates of complications based on flap type (latissimus, radial forearm, ALT, other); type of cranioplasty (mesh, methyl methacrylate, bone flap); and defect location. Complications were divided into major and minor. Major complications included flap failure, need for reoperation within 30 days, readmission to the hospital, and death. Minor complications included seromas, dehiscence, graft edge loss/necrosis, and other complications not needing surgical correction.

Results: A total of 46 studies with a total of 964 patients met the inclusion criteria. The most commonly used flap was a latissimus dorsi. There was no difference in major complication rates when comparing flap types (ALT vs latissimus, OR 1.16, 95%CI 0.35-3.87); (radial forearm vs latissimus, OR 0.37, 95% CI 0.05-2.61); (other flaps vs latissimus, OR 1.25, 95%CI 0.35-4.52). There were also no differences in minor complications.

Conclusions: The choice of free flap does not appear to affect complication rates after microsurgical reconstruction of scalp and calvarial defects.