Reconstruction of Extensive Scalp Defects with Free Tissue Transfer

Abstract

Whole layer scalp defects may be caused by tumor excision, infection, burn injury or traumatic amputation of scalp. Adequate coverage of bared scalp bone with durable skin and soft tissue is necessary when reconstructing such kind of defect. When the defects are extensive, free tissue transfer is a good option for reconstruction. In our experience of 12 patients with 13 large scalp defects underwent 13 microsurgical free flaps, with one of them was bi-paddle flap. The average area of full thickness scalp defect was 105.5 cm^2. The anterolateral thigh perforator flap comprised majority of the free flaps harvested (7 cases, 57%), while the latissimus dorsi muscle, gracilis muscle and rectusw abdominis muscle flaps had two each. The survival rate of 13 flaps was 100%. Two long term complication were noted in patients reconstructead with free muscle flaps combined with skin grafts. Our experience showed that free tissue transfer can provide durable skin and soft tissue coverage for large scalp defect. Superficial temoral artery and vein are ideal recipient vessels for most cases.