{'fraction_non_alphanumeric': 0.027393044013542627, 'fraction_numerical': 0.015081563558017852, 'mean_word_length': 5.052141527001862, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
The scalping flap for reconstruction of upper cranial and cranial base defects.

Since the application of the scalping flap by Converse in 1942 for nasal reconstruction, its utility has expanded significantly.1–3 In the late 1970s, this flap was used successfully in cheek, eyebrow, and orbital roof restoration.4 It subsequently gained popularity in the reconstruction of the nasopharynx, tonsil, and floor of the mouth.5 In the early 1990s, we presented the unique applicability of this flap in the immediate reconstruction of upper cranial and cranial base defects.6 We retrospectively reviewed 11 patients from 1991 to 1994 who received a scalping flap for soft-tissue coverage of anterior cranial or cranial base defects resulting from resection of various malignancies. All of these patients were treated by the senior author. In six cases, the scalping flap involved a single procedure; in five other cases, flap division and insetting were carried out in a subsequent operation. In six of the 11 cases, the flap was used to cover the frontal bone and cranial base; in the remaining five cases, frontal bone, cranial base, and nasal coverage was obtained. The flap was sufficiently vibrant to provide satisfactory coverage of free bone grafts used to reconstruct the anterior skull, skull base, and supraorbital bar. The flap also provided good color and texture match in an area critical to facial aesthetics. Furthermore, the procedure was well tolerated, with a short average hospitalization of 5.9 days and no major complications during a follow-up period ranging from 11 months to 5 years. Moreover, the technical advantages of this flap included (1) contiguous availability, (2) simplicity of application, with operative times ranging from 60 to 75 minutes, and (3) a robust and redundant blood supply, including anastomotic networks among the superficial temporal, supratrochlear, and supraorbital vessels. Since our last report, we have used the scalping flap as the sole means of reconstructing and providing soft-tissue coverage of the anterior upper cranium, skull base, and nasal unit in 19 additional cases. Unlike our original series, we had one major complication in a 69year-old man who had undergone four previous resections by other surgeons as well as a course of postoperative irradiation for a recurrent squamous cell carcinoma of the supraorbital region. He presented with upper eyelid and orbital fat involvement as well as extension through the roof of his orbit. He underwent an en bloc resection of his orbital contents and right orbital roof to the orbital apex (Fig. 1, above, left and right). Dura was resected and then reconstructed with a fascial patch graft. The orbital roof was reconstructed with autogenous bone grafts and titanium mesh (Fig. 1, center, left). Finally, soft-tissue coverage was provided with a scalping flap (Fig. 1, center, right, and below, left). The patient was discharged home uneventfully after a 5-day hospitalization. He resumed normal activities shortly thereafter, with the only complaint being a persistent cough, which was attributed to his chronic lung disease. On the eleventh postoperative day, the patient developed a low-grade fever, which progressed to disorientation over