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Introduction <p>Scalp erosion with shunt exposure is a challenging complication in pediatric patients receiving a ventriculoperitoneal (VP) shunt, often requiring shunt removal due to infection concerns. This study aimed to evaluate the surgical outcomes and shunt-salvage potential of scalp transposition flap reconstruction in pediatric patients with exposed VP shunts in the absence of active cerebrospinal fluid (CSF) infection.</p> Methods <p>We retrospectively reviewed medical records of 1254 pediatric patients undergoing VP shunt placement and followed up for shunt exposure at a tertiary university hospital between May 2021 and December 2025. Thirty patients developed wound-related complications at the shunt entry site, of which seven had active CSF infection or meningitis. The remaining 23 patients (13 females and 10 males; mean age = 1.40 ± 1.26&#xa0;years) were confirmed clinically and radiologically for preserved shunt function, absence of CSF leakage at the wound site, and absence of clinical, laboratory, or microbiological evidence of meningitis or CSF infection; they underwent scalp transposition flap reconstruction performed jointly by senior neurosurgery and plastic surgery teams. Demographic characteristics, perioperative findings, and postoperative outcomes of the 23 patients were analyzed descriptively.</p> Results <p>The overall incidence of scalp necrosis was 2.39% (<i>n </i>= 30/1254), whereas that among patients without CSF leakage was 1.83% (<i>n</i> = 23/1254). The mean follow-up duration was 7.4 ± 2.77&#xa0;months. Five patients (21.7%) sustained partial flap loss, which resolved with conservative management. Shunt revision was required in five patients (21.7%) during follow-up. No patient developed postoperative CSF leakage, central nervous system infection, flap-related complications, or recurrent shunt exposure.</p> Conclusion <p>Scalp transposition flap reconstruction is a safe and effective option for managing exposed VP shunts in pediatric patients without active CSF infection. This approach preserves functional shunt systems and helps reduce the need for shunt removal and additional staged surgical procedures.</p>

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Surgical outcomes of scalp transposition flap reconstruction in pediatric patients with ventriculoperitoneal shunt exposure

  • 期刊论文

  • 发表日期：

    2026年4月14日

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  • Necati Ucler,
  • Recep Anlatici,
  • Yigit Aksogan,
  • Ali Nehir,
  • Berna Kaya Ugur,
  • Murat Geyik

摘要

Introduction

Scalp erosion with shunt exposure is a challenging complication in pediatric patients receiving a ventriculoperitoneal (VP) shunt, often requiring shunt removal due to infection concerns. This study aimed to evaluate the surgical outcomes and shunt-salvage potential of scalp transposition flap reconstruction in pediatric patients with exposed VP shunts in the absence of active cerebrospinal fluid (CSF) infection.

Methods

We retrospectively reviewed medical records of 1254 pediatric patients undergoing VP shunt placement and followed up for shunt exposure at a tertiary university hospital between May 2021 and December 2025. Thirty patients developed wound-related complications at the shunt entry site, of which seven had active CSF infection or meningitis. The remaining 23 patients (13 females and 10 males; mean age = 1.40 ± 1.26 years) were confirmed clinically and radiologically for preserved shunt function, absence of CSF leakage at the wound site, and absence of clinical, laboratory, or microbiological evidence of meningitis or CSF infection; they underwent scalp transposition flap reconstruction performed jointly by senior neurosurgery and plastic surgery teams. Demographic characteristics, perioperative findings, and postoperative outcomes of the 23 patients were analyzed descriptively.

Results

The overall incidence of scalp necrosis was 2.39% (n = 30/1254), whereas that among patients without CSF leakage was 1.83% (n = 23/1254). The mean follow-up duration was 7.4 ± 2.77 months. Five patients (21.7%) sustained partial flap loss, which resolved with conservative management. Shunt revision was required in five patients (21.7%) during follow-up. No patient developed postoperative CSF leakage, central nervous system infection, flap-related complications, or recurrent shunt exposure.

Conclusion

Scalp transposition flap reconstruction is a safe and effective option for managing exposed VP shunts in pediatric patients without active CSF infection. This approach preserves functional shunt systems and helps reduce the need for shunt removal and additional staged surgical procedures.