{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:17:12Z","timestamp":1790605032254,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T00:00:00Z","timestamp":1681862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Complex scalp defects are regularly reconstructed using microvascular tissue transfer. The latissimus dorsi free flap is one of the workhorse flaps used in scalp reconstruction. These cases necessitate, particularly in the elderly, a close cooperation between plastic surgeons and neurosurgeons. The purpose of this study was to evaluate the suitability of the latissimus dorsi free flap for complex scalp reconstructions and to analyze potential risk factors. Methods: A retrospective study identified 43 patients undergoing complex scalp reconstruction using a latissimus dorsi free flap at our department between 2010 and 2022. Results: The mean patient age was 61 \u00b1 18 years. Defects were mostly caused by oncologic tumor resections (n = 23; 55%), exposure to a cranioplasty (n = 10; 23%) or infection (n = 4; 9%). The most frequent recipient vessels were the superficial temporal artery (n = 28; 65%), external carotid artery (n = 12; 28%) and the venae comitantes (n = 28; 65%), external jugular vein (n = 6; 14%). The reconstructive success rate was 97.7%. There was one total flap loss (2%). Partial flap loss occurred in five cases (12%). Follow-up was 8 \u00b1 12 months. Major complications were seen in 13 cases, resulting in a revision rate of 26%. Multivariate logistic regression identified active tobacco use as the only risk factor for major complications (odds ratio 8.9; p = 0.04). Conclusion: Reconstruction of complex scalp defects using the latissimus dorsi free flap yielded high success rates. Among the potential risk factors, active tobacco use seems to affect the outcome of complex scalp reconstructions.<\/jats:p>","DOI":"10.3390\/jcm12082953","type":"journal-article","created":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T01:09:22Z","timestamp":1681866562000},"page":"2953","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Scalp Reconstruction Using the Latissimus Dorsi Free Flap: A 12-Year Experience"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1467-9224","authenticated-orcid":false,"given":"Felix","family":"Str\u00fcbing","sequence":"first","affiliation":[{"name":"Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany"},{"name":"Department of Hand and Plastic Surgery, University of Heidelberg, 69117 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Wenz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nima","family":"Etminan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, 68167 Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8852-5132","authenticated-orcid":false,"given":"Amir K.","family":"Bigdeli","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany"},{"name":"Department of Hand and Plastic Surgery, University of Heidelberg, 69117 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura C.","family":"Siegwart","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany"},{"name":"Department of Hand and Plastic Surgery, University of Heidelberg, 69117 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4185-178X","authenticated-orcid":false,"given":"Benjamin","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany"},{"name":"Department of Hand and Plastic Surgery, University of Heidelberg, 69117 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Vollbach","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany"},{"name":"Department of Hand and Plastic Surgery, University of Heidelberg, 69117 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Vogelpohl","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany"},{"name":"Department of Hand and Plastic Surgery, University of Heidelberg, 69117 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3402-2860","authenticated-orcid":false,"given":"Ulrich","family":"Kneser","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany"},{"name":"Department of Hand and Plastic Surgery, University of Heidelberg, 69117 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2826-2793","authenticated-orcid":false,"given":"Emre","family":"Gazyakan","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany"},{"name":"Department of Hand and Plastic Surgery, University of Heidelberg, 69117 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"237","DOI":"10.7181\/acfs.2020.00269","article-title":"Scalp reconstruction: A 10-year experience","volume":"21","author":"Jang","year":"2020","journal-title":"Arch. Craniofacial Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.jcms.2016.11.023","article-title":"Scalp reconstruction: A 10-year retrospective study","volume":"45","author":"Steiner","year":"2016","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"710","DOI":"10.3171\/2015.4.JNS159","article-title":"Cranioplasty after decompressive craniectomy: Is there a rationale for an initial artificial bone-substitute implant? A single-center experience after 631 procedures","volume":"124","author":"Schwarz","year":"2016","journal-title":"J. Neurosurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1002\/micr.30800","article-title":"The use of free myocutaneous flap and implant reinsertion for staged cranial reconstruction in patients with titanium mesh exposure and large skull defects with soft tissue infection after cranioplasty: Report of 19 cases","volume":"41","author":"Han","year":"2021","journal-title":"Microsurgery"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"122","DOI":"10.3109\/02688697.2015.1080216","article-title":"Cranioplasty outcomes and associated complications: A single-centre observational study","volume":"30","author":"Liang","year":"2015","journal-title":"Br. J. Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1097\/SCS.0000000000004478","article-title":"Complications of Cranioplasty","volume":"29","author":"Sahoo","year":"2018","journal-title":"J. Craniofacial Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1016\/j.clineuro.2012.12.002","article-title":"Cranioplasty after decompressive hemicraniectomy: Underestimated surgery-associated complications?","volume":"115","author":"Wachter","year":"2013","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1001\/jamafacial.2014.889","article-title":"Scalp Reconstruction: An Algorithmic Approach and Sys-tematic Review","volume":"17","author":"Desai","year":"2015","journal-title":"JAMA Facial Plast. Surg."},{"key":"ref_9","unstructured":"Zenn, M.R., and Jones, G. (2012). Reconstructive Surgery: Anatomy, Technique, and Clinical Application, Taylor and Francis."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hanasono, M., Robb, G., Skoracki, R., and Yu, P. (2016). Reconstructive Plastic Surgery of the Head and Neck: Current Techniques and Flap Atlas, Thieme.","DOI":"10.1055\/b-0036-134342"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.bjps.2020.10.016","article-title":"Random-pattern versus perforator-based adipocutaneous skin paddles for postoperative monitoring of free muscle flaps\u2014A comparative retrospective cohort study","volume":"74","author":"Nagel","year":"2020","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1177\/0194599819860809","article-title":"Factors Associated with Free Flap Failures in Head and Neck Reconstruction","volume":"161","author":"Crawley","year":"2019","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.bjps.2016.03.021","article-title":"Microsurgical reconstruction of oncological scalp defects in the elderly","volume":"69","author":"Simunovic","year":"2016","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1002\/micr.30189","article-title":"The effect of age on microsurgical free flap outcomes: An analysis of 5,951 cases","volume":"37","author":"Jubbal","year":"2017","journal-title":"Microsurgery"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1055\/s-0031-1301070","article-title":"Free Flap Scalp Reconstruction in a 91-Year-Old Patient under Local-Regional Anesthesia: Case Report and Review of the Literature","volume":"28","author":"Carey","year":"2012","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1097\/SCS.0000000000006421","article-title":"Free Flap Reconstruction of Complex Oncologic Scalp Defects in the Setting of Mesh Cranioplasty: Risk Factors and Outcomes","volume":"31","author":"Othman","year":"2020","journal-title":"J. Craniofacial Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1055\/s-0038-1636939","article-title":"Free-Flap Lower Extremity Reconstruction: A Cohort Study and Meta-Analysis of Flap Anastomotic Outcomes between Perforator and Nonperforator Flaps","volume":"34","author":"Song","year":"2018","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1002\/micr.30219","article-title":"Evaluation of 389 patients following free-flap lower extremity reconstruction with respect to secondary refinement procedures","volume":"38","author":"Kotsougiani","year":"2017","journal-title":"Microsurgery"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1055\/s-0038-1667363","article-title":"Limb Salvage and Functional Outcomes following Free Tissue Transfer for the Treatment of Recalcitrant Diabetic Foot Ulcers","volume":"35","author":"Lu","year":"2018","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"514e","DOI":"10.1097\/PRS.0000000000000505","article-title":"Perioperative Outcomes of Autologous Breast Reconstruction Surgery in Teaching versus Nonteaching Hospitals","volume":"134","author":"Masoomi","year":"2014","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_21","first-page":"530","article-title":"Microsurgical Scalp Reconstruction: An Overview of the Contemporary Approach","volume":"38","author":"Song","year":"2021","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"067","DOI":"10.1055\/s-0039-1678470","article-title":"Free Tissue Reconstruction of the Scalp","volume":"33","author":"Sokoya","year":"2019","journal-title":"Semin. Plast. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"586e","DOI":"10.1097\/PRS.0b013e3182419c54","article-title":"Perforator-Based Monitoring Skin Islands in Free Muscle Flaps","volume":"129","author":"Beier","year":"2012","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.3389\/fonc.2019.01130","article-title":"A Standard Algorithm for Reconstruction of Scalp Defects With Simultaneous Free Flaps in an Interdisciplinary Two-Team Approach","volume":"9","author":"Weitz","year":"2019","journal-title":"Front. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1002\/micr.30345","article-title":"Reconstruction of cranioplasty using the thoracodorsal artery perforator (TDAP) flap: A case series","volume":"39","author":"Scaglioni","year":"2018","journal-title":"Microsurgery"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.oraloncology.2017.10.019","article-title":"Head and neck reconstruction with free flaps based on the thoracodorsal system","volume":"75","author":"Bajwa","year":"2017","journal-title":"Oral Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.anorl.2015.06.003","article-title":"Comparison of radial forearm flap and thoracodorsal artery perforator flap donor site morbidity for reconstruction of oral and oropharyngeal defects in head and neck cancer","volume":"132","author":"Bach","year":"2015","journal-title":"Eur. Ann. Otorhinolaryngol. Head Neck Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.bjoms.2015.11.021","article-title":"Prospective biomechanical evaluation of donor site morbidity after radial forearm free flap","volume":"54","author":"Riecke","year":"2015","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1002\/hed.21999","article-title":"Microsurgical reconstruction of composite scalp and calvarial defects in patients with cancer: A 10-year experience","volume":"34","author":"Chao","year":"2012","journal-title":"Head Neck"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"089","DOI":"10.1055\/s-0032-1329918","article-title":"A 15-year Experience of Complex Scalp Reconstruction Using Free Tissue Transfer\u2014Analysis of Risk Factors for Complications","volume":"29","author":"Sieber","year":"2012","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1097\/01.prs.0000287273.48145.bd","article-title":"Superficial Temporal Artery and Vein as Recipient Vessels for Facial and Scalp Microsurgical Reconstruction","volume":"120","author":"Hansen","year":"2007","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1055\/s-0034-1394160","article-title":"Superficial Temporal Artery and Vein as Recipient Vessels for Scalp and Facial Reconstruction: Radiographic Support for Underused Vessels","volume":"31","author":"Doscher","year":"2015","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1097\/PRS.0000000000004770","article-title":"Interposition Vein Grafting in Head and Neck Free Flap Reconstruction","volume":"142","author":"Maricevich","year":"2018","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2914","DOI":"10.1002\/hed.25767","article-title":"Outcomes following head neck free flap reconstruction requiring interposition vein graft or vascular bridge flap","volume":"41","author":"Chen","year":"2019","journal-title":"Head Neck"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1097\/PRS.0000000000005386","article-title":"One-Stage versus Two-Stage Arteriovenous Loop Reconstructions: An Experience on 103 Cases from a Single Center","volume":"143","author":"Henn","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"13902","DOI":"10.1038\/s41598-022-18216-6","article-title":"Smoking and microvascular free flap perfusion in head and neck reconstruction: Radial free forearm flaps and anterolateral thigh flaps","volume":"12","author":"Ooms","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Garip, M., Croonenborghs, T.-M., Bila, M., Vranckx, J.J., and Politis, C. (J. Craniofacial Surg., 2021). The Effect of Smoking on the Postoperative Course After Head and Neck Reconstruction With a Vascularized Free Flap: A Retrospective Study, J. Craniofacial Surg., publish ahead of print.","DOI":"10.1097\/SCS.0000000000007526"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1002\/lary.22454","article-title":"Predictors of complications of free flap reconstruction in head and neck surgery: Analysis of 304 free flap reconstruction procedures","volume":"122","author":"Higgins","year":"2012","journal-title":"Laryngoscope"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1001\/jamafacial.2018.1176","article-title":"Association of Smoking Tobacco With Complications in Head and Neck Microvascular Reconstructive Surgery","volume":"21","author":"Crippen","year":"2019","journal-title":"JAMA Facial Plast. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1177\/2292550317749509","article-title":"Smoking and Flap Survival","volume":"26","author":"Hwang","year":"2018","journal-title":"Plast. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"314","DOI":"10.3109\/02688697.2015.1012047","article-title":"Sinking skin flap syndrome (or Syndrome of the trephined): A review","volume":"29","author":"Annan","year":"2015","journal-title":"Br. J. Neurosurg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1097\/SCS.0000000000004063","article-title":"Neuroplastic Surgery","volume":"29","author":"Gordon","year":"2018","journal-title":"J. Craniofacial Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.cps.2020.12.007","article-title":"Orthoplastic Approach to Lower Extremity Reconstruction","volume":"48","author":"Steinberger","year":"2021","journal-title":"Clin. Plast. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1055\/a-1924-6581","article-title":"Etablierung von interdisziplin\u00e4ren Extremit\u00e4tenboards: Ein wichtiger Beitrag zur Verbesserung der Versorgung von Patienten mit komplexem Extremit\u00e4tentrauma","volume":"160","author":"Gramlich","year":"2022","journal-title":"Z. Orthop\u00e4die Unf."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/8\/2953\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:18:37Z","timestamp":1760123917000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/8\/2953"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,19]]},"references-count":44,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["jcm12082953"],"URL":"https:\/\/doi.org\/10.3390\/jcm12082953","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,19]]}}}