Abstract
Importance Scalp reconstructions may be required after tumor resection or trauma. The inherent
anatomy of the scalp presents challenges and may limit reconstructive options.
Objective To describe and investigate the scalp rotation flap as a reconstructive technique
for complex soft tissue defects.
Design Retrospective case series with a mean follow-up of 13 months.
Setting Tertiary academic center.
Participants A total of 22 patients with large scalp soft tissue defects undergoing scalp rotation
flap reconstruction.
Interventions The flap is designed adjacent to the defect and elevated in the subgaleal plane.
The flap is rotated into the defect, and a split-thickness skin graft is placed over
the donor site periosteum.
Main Outcomes and Measure Data points collected included defect size, operative time, hospital stay, and patient
satisfaction with cosmetic outcome.
Results Mean patient age was 71 years. Mean American Society of Anesthesiologist classification
was 2.8. Mean defect size was 41 cm2 (range: 7.8–120 cm2), and 19 of 22 defects resulted from a neoplasm resection. Mean operative time was
181 minutes, and mean hospital stay was 2.4 days. There were no intraoperative complications.
Three patients with previous radiation therapy had distal flap necrosis. Twenty-one
patients (95%) reported an acceptable cosmetic result.
Conclusions and Relevance The scalp rotation flap is an efficient and reliable option for reconstructing complex
soft tissue defects. This can be particularly important in patients with significant
medical comorbidities who cannot tolerate a lengthy operative procedure.
Keywords
oncology - scalp reconstruction - reconstruction - local flap
