The Use of the Occipital Scalp Rotational Flap for Reconstruction after Lateral Temporal Bone Resection.

Introduction: Oncologic surgery of the lateral skull base can result in complex defects exposing middle ear and mastoid contents as well as nearby dura and major neurovascular structures. Inadequate coverage can result in wound breakdown and severe complications such as osteomyelitis and meningitis, with the potential to delay adjuvant therapy. Previously described techniques such as pedicled myocutaneous flaps and free tissue transfers provide adequate soft tissue coverage, but come with significant donor site morbidity and may not be appropriate for individuals with poor baseline health status. This article describes the use of the occipital scalp rotational flap, based on the occipital artery, as an alternative reconstructive technique for lateral temporal bone defects in patients with significant medical comorbidities.

Methods: A retrospective medical record review of seven patients receiving an occipital scalp rotational flap for reconstruction after lateral temporal bone resection was performed. Patient variables included age at surgery and the presence or absence of preoperative and postoperative radiation therapy. The patients' gender, pathologic diagnosis, extent of surgical resection, and medical comorbidities were also recorded. Clinical outcomes included minor wound complications, major wound complications, and donor site complications.

Results: The patients' mean age was 69.2 years. One patient received preoperative radiation therapy and six received postoperative radiation therapy. There were minor wound complications in two patients and no major wound complications. There were no significant donor site complications.

Conclusion: The occipital scalp rotational flap is reliable and should be considered as a viable option for reconstruction after lateral temporal bone resection in select patients.