Free latissimus dorsi muscle flap for scalp reconstruction in elderly patients with a squamous cell carcinoma

Background Scalp defects resulting from the resection of a squamous cell carcinoma often require free tissue transfer. In these cases, a free latissimus dorsi muscle flap is a good possibility to cover scalp defects. Our aim was to evaluate the outcome of scalp coverage with free latissimus dorsi muscle flaps. Methods This retrospective analysis included 4 patients aged over 70 years (7082), who underwent scalp reconstruction with a free latissimus dorsi muscle flap and a split-skin graft after the resection of a squamous cell carcinoma. Patient characteristics, histological findings, recurrence rate, postoperative radiotherapy, duration of operation and in-patient stay were recorded. Results All 4 patients had recurrent tumours and the follow-up period was 12-48 months. Histological findings demonstrated R0 resection in all patients. A PALACOS (R) bone was necessary in two patients and duraplasty in one. All free flaps healed without major complications. There was no flap loss; minor complications included seromas and wound dehiscence. One patient died during follow-up and two were no longer treatable due to tumour progression. One patient is still alive and has had no recurrence for 22 months. Conclusion Free latissimus dorsi muscle flap is a reliable method to reconstruct large scalp defects, even in elderly patients, due to its low complication rate and good tissue vascularity. Despite R0 resection with partial resection of the skullcap and duraplasty, there is a high risk for local recurrence. A multidisciplinary approach is necessary to achieve the best therapy concept for each patient.