Dual transposition flaps for the reconstruction of large scalp defects

Abstract

Large scalp defects can be challenging to repair because of the inelasticity of the scalp. While there are several methods to close this type of wound, they result in either alopecia or unacceptable scarring. We present a dual transposition flap to close a large defect following Mohs surgery for a basal cell carcinoma on the scalp. We describe and report the case of a man with a basal cell carcinoma on the scalp vertex who had been referred for Mohs micrographic surgery. The surgery resulted in a large scalp defect. A dual transposition flap performed with tumescent anesthesia was used in a delayed closure of a 78.5-cm2 defect. It resulted in minimal alopecia, minimal distortion of the hair orientation, and minimal scar stretch-back. The limitation of this study is that this technique is based on one case report. This dual transposition flap is a good reconstructive option for large, immobile scalp defects. It can be performed under local anesthesia with minimal alopecia and camouflaged scars.