Microsurgical Reconstruction of Scalp Defects
Summary
Scalp defects arising from tumour resection, trauma, burns or radiation pose significant reconstructive challenges. The scalp’s unique convex anatomy, limited tissue laxity and proximity to the calvarium demand robust, vascularised coverage to protect intracranial structures, restore contour and ensure durable wound healing. While small to medium defects may be addressed by local or pedicled flaps, large or composite defects often necessitate microsurgical free tissue transfer. Advances in preoperative imaging, intraoperative planning and vessel selection have refined the choice of donor sites—commonly the latissimus dorsi, anterolateral thigh and parascapular flaps—optimising both functional and aesthetic outcomes. Interdisciplinary collaboration between neurosurgery, plastic surgery and oncology is now integral to achieving stable reconstruction, particularly in patients with prior radiotherapy or multiple operations. Recent developments have emphasised standardised algorithms, two-team approaches and novel flap combinations to streamline operative time and minimise complications. Successful scalp reconstruction not only restores protective coverage but also improves quality of life, underlining its global clinical significance.
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Microsurgical Reconstruction of Scalp Defects publication trend
The graph below shows the total number of articles in microsurgical reconstruction of scalp defects across all publications each year (not limited to Nature Index journals).
Technical terms
Microsurgical free flap: Transfer of tissue with microvascular anastomosis to recipient vessels at the defect site.
Recipient vessels: Local arteries and veins selected to provide inflow and outflow for the transferred flap.
Pedicled flap: Tissue transferred with its original blood supply preserved, rotated or advanced into an adjacent defect.
Anastomosis: Surgical connection between donor and recipient blood vessels under magnification.
Two-team approach: Concurrent operative technique whereby one team harvests the flap while the other prepares the defect site.
References
- A Standard Algorithm for Reconstruction of Scalp Defects With Simultaneous Free Flaps in an Interdisciplinary Two-Team Approach. Frontiers in Oncology (2019).
- Clinical and Surgical Outcomes in Extensive Scalp Reconstruction after Oncologic Resection: A Comparison of Anterolateral Thigh, Latissimus Dorsi and Omental Free Flaps. Journal of Clinical Medicine (2021).
- Scalp Reconstruction Using the Latissimus Dorsi Free Flap: A 12-Year Experience. Journal of Clinical Medicine (2023).
- Multidisciplinary Management of Cutaneous Squamous Cell Carcinoma of the Scalp: An Algorithm for Reconstruction and Treatment. Journal of Clinical Medicine (2024).
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