Scalp Reconstruction

Excerpt

Scalp reconstruction procedures range from those for medical indications to those for cosmetic reasons. Koss et al. made a detailed analysis of trauma-related scalping injuries and their management. The history of scalp reconstruction techniques mirrors that of plastic surgery techniques, including the use of free flaps for very large defects.

More typical procedures include incisional and excisional biopsies, excision of benign and malignant tumors, and scalp reduction surgery. Benign lesions of the scalp that are excisable include epidermoid cysts, nevus sebaceus, and blue and melanocytic nevi. Malignant lesions that typically undergo excision include basal and squamous cell carcinoma, Bowen disease, Merkel cell carcinoma, and malignant melanoma. Wounds created from these procedures may be small and superficial and amenable to primary closure but often are large, deep (down to calvaria), and extensive, needing more complex closure and covering.

Scalp reconstruction surgery has been used in the past to treat alopecia but is rarely used nowadays due to advances in hair transplantation. Cosmetic indications are not in the remit of this article and will not be part of the discussion here.

Reconstruction of the scalp follows the reconstructive ladder of any other plastic surgical procedure: granulation (secondary intention); primary closure; advancement flap; rotational flap; use of split-thickness skin graft (STSG); or full-thickness skin graft (FTSG); and free flaps. The selection of one or a combination of methods depends on anatomical (skin laxity, wound depth, location) and patient-related factors (smoker, wound care, general health).

Traumatic scalp avulsive injuries can occur and be devastating. These can be addressed as above with other defects or require potentially significantly more extensive surgeries both in regards to the number and complexity.