Fig. 4.10  Omental free flap. The patient is status post motorcycle accident during which loss of cranial bone occurred. Coronal CT image shows the flap overlying the right hemicraniectomy site contains fat and omental vessels and is covered by skin graft

4.7\ Scalp Tumor Recurrence

4.7.1\ Discussion

Most recurrent tumors manifest within the first 2 years following resection and are most common­ in the tumor bed near the anastomosis. Imaging can detect both locoregional recurrence and the extent of intracranial extension of recurrent tumors (Fig. 4.11). Postoperative imaging can also help in distinguishing tumor recurrence from fibrosis related to the surgery or radiation therapy. Recurrent tumors typically appear as nodular foci of enhancement and have higher T2-weighted signal intensity on MRI than fibrosis.

Fig. 4.11  Skin tumor recurrence. The patient has a history of locally invasive squamous cell carcinoma, presenting as a large fungating scalp lesion. Axial preoperative CT image (a) shows a right frontal scalp mass that invades the

underlying skull. CT images obtained 14 months after surgery (b) show an enhancing mass (arrow) deep to the myocutaneous free flap. There are also several metastatic nodules in the left scalp