ABSTRACT
Large, full-thickness scalp defects represent a reconstructive challenge that has
benefitted greatly from the introduction of microsurgical techniques. The authors
review their experience with 16 patients with acquired defects of the scalp for which
local or regional reconstructive options were unavailable. The mean age at the time
of operation was 44.8 years. Nine patients underwent resection of malignant scalp
lesions, followed immediately by free-flap coverage. Six patients required revision
procedures for unstable scar as a result of prior trauma (2), old scalp avulsions
(2), and multiple intracranial procedures (2). The remaining patient underwent replantation
of an acutely avulsed scalp. The free-flap donor sites utilized included latissimus
(6), scapular (3), radial forearm (2), rectus abdomnis (2), and omentum (2). Vein
grafts were required in four cases. All flaps survived, although one required anastomotic
revision and skin grafting for superficial loss. Additional complications were limited
to seromas at two latissimus donor sites. Tumor control rates were poor, with all
malignancy-associated defects having persistent disease or recurring soon after surgery.
All patients eventually achieved full defect coverage. The authors conclude that microsurgical
reconstruction is a reliable option for providing stable coverage of large, complex,
scalp defects.
