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

Objective: Assess the patient demographics, comorbidities, tumor and defect characteristics, and operative variables associated with wound complications of scalp defects reconstructed with local flaps for cutaneous malignancies. Study Design: Case-control. Setting: Academic medical center from January 1, 2019, to August 1, 2024. Methods: Cases were defined by the presence of any of the following: infection, necrosis, and/or dehiscence of the surgical site. Controls had no wound complications. Odds ratio and adjusted odds ratio (aOR) with 95% confidence intervals were calculated for the predictors using binomial univariate and multivariable logistic regression. Results: A total of 110 patients (74% males) underwent scalp reconstruction with local flaps (median [min-max] age: 75 years [26-94]). The most common local flaps used were the snail (n = 49, 45%), double hatchet (n = 25, 23%), and large bilobed transposition flaps (n = 15, 14%). The average mean scalp defect diameter of the cohort was 5.5 cm, ranging from 2.5 to 14.0 cm. Forty-two (38%) patients experienced any wound complications with 13 (12%) major wound complications. Moderate-to-severe comorbidity status (aOR 5.1 [1.9-13.4]) and active smoking status (aOR 8.3 [1.2-57.7]) were independently associated with any wound complications. Variables not associated with wound complications were immunosuppression, type of local flap used, size of defect, preservation of hair, and suture type. There was a significant decrease in complications over time. Conclusion: Major wound complications are infrequent with local scalp flaps in properly selected patients. Moderate-to-severe comorbidity status and active smoking are significant risk factors for wound complications. Improved outcomes over time suggest a learning curve associated with using local scalp flaps. A novel algorithm for scalp reconstruction of cutaneous malignancies is proposed.