Long-Term Outcomes of Free Flaps for Skull Coverage: A Retrospective Review

In a retrospective review, Geoffrey G. Hallock, MD, assessed the long-term outcomes of 14 free flaps used for skull coverage in 12 patients between 1982 and 2003. The study compared 8 muscle-only free flaps to 6 composite free flaps and found that muscle-only free flaps were more prone to serious long-term complications like implant extrusion and chronic ulcerations. These issues were linked to the flaps' thinness, possibly due to muscle atrophy or the initial choice of a too-thin flap. The average follow-up period was 43.0 months for the muscle-only group and 23.7 months for the composite group. The study concluded that for a permanent, trouble-free outcome, either composite flaps or sufficiently thick muscle flaps should be selected from the start, suggesting that composite flaps might be better for long-term skull coverage in some cases.