Background and Objectives: Before the introduction of griseofluvin, the use of X-ray radiation was the treatment of choice for
tinea capitis. More than half a century later various types of
tumors have been found to be associated with childhood irradiation due to
tinea capitis, most commonly
cancers of the head and neck, as well as
brain tumors. The often unusually aggressive and recurrent nature of these
tumors necessitates the need for repeated surgeries, while the atrophic skin with an impaired vascular supply due to radiation often poses an additional challenge for defect reconstruction. We present our experience in the surgical treatment of such patients. Materials and Methods: This is a retrospective cohort study. In this study, 37 patients treated for acquired defects of the scalp with a history of irradiation
therapy due to
tinea capitis in childhood were included in this study, 24 male and 13 female patients. The mean age at the first appointment was 60.6 ± 7.8, with the youngest included patient being 46 and the oldest being 75 years old. Patients' characteristics, surgical treatment, and complications were analyzed and a reconstructive algorithm was developed. Results: Local flaps were used for reconstruction in 34 patients, direct
sutures were used in 10 patients and 20 patients received split-thickness skin grafts for coverage of both primary and secondary defects for reconstruction of flap donor sites. One regional flap and one dermal substitute covered by an autologous skin graft were also used for reconstruction. Complications occurred in 43.2% of patients and were significantly associated with the presence of comorbidities (p = 0.001), aseptic
bone necrosis (p = 0.001), as well as skin
atrophy in frontal, occipital, and parietal region (p = 0.001, p = 0.042 and p = 0.001, respectively). A significant correlation between major complications and moderate skin
atrophy was found only in the parietal region (p = 0.026). Conclusions: Unfortunately, many protocols developed for scalp reconstruction are not applicable in the setting of severe or diffuse scalp skin
atrophy associated with high
tumor recurrence rate and radiation-induced vascular impairment, such as in
tinea capitis patients in Serbia. An algorithm has been developed based on the authors' experience in managing these patients.