Reconstruction of scalp with local axial flaps


  • Saket Srivastava Department of Plastic Surgery, SMS Medical College, Jaipur, Rajasthan, India
  • Pradeep Gupta Department of Plastic Surgery, SMS Medical College, Jaipur, Rajasthan, India



Scalp, Fasciocutaneous flaps, Electric burn, Reconstructive surgery, Cutaneous malignancy


Background: The scalp is a unique part of the human body and various etiological factors, such as tumour extirpation, infection, burns, or trauma, can lead to scalp defects. Primary closure, skin grafting, local flaps, tissue expansion or free tissue transfer are modalities available for scalp reconstruction. In this article, the authors share their institutional experience using various local flaps concerning the size, location, depth of defect and the quality of surrounding tissue.

Methods: From September 2017 to January 2020, 54 patients underwent scalp reconstruction with local flaps for a defect size of 5 to 150 cm2 in the department of plastic surgery, SMS medical college, Jaipur. Patients were identified by age, sex, cause of the scalp defect; the location, size, and depth of the defect; condition of surrounding tissue and the type of reconstruction done.

Results: The most common cause of scalp defect was excision of malignant tumour (50%). Thirty patients had a large sized defect (40-90 cm2) and 28 patients had 90-150 cm2 defects. Surgical reconstruction was done using local flaps, transposition flap was the most used in 36 patients (66.7%) followed by rotation advancement flap in 11 patients (20.4%). The recovery was relatively quick. Minor complications happened in 5 patients (9.3%) that were managed conservatively.

Conclusions: In the present era of microsurgical reconstruction, local options as axial flaps provide a simpler and safer method of scalp reconstruction. A carefully planned scalp flap gives healthy, robust, hair-bearing tissue coverage and requires a shorter healing time for the patients.

Author Biographies

Saket Srivastava, Department of Plastic Surgery, SMS Medical College, Jaipur, Rajasthan, India

Senior Resident,

Dept Of Plastic Surgery

Pradeep Gupta, Department of Plastic Surgery, SMS Medical College, Jaipur, Rajasthan, India

Senior Professor,

Department of Burns And Plastic Surgery,



Shestak KC, Ramasastry SS. Reconstruction of defects of the scalp and skull. In: Cohen M, ed. Mastery of plastic and reconstructive surgery. Boston, MA: Little Brown; 1994:830-41.

Lutz BS, Wei FC, Chen HC, Lin CH, Wei CY. Reconstruction of scalp defects with free flaps in 30 cases. Br J Plast Surg. 1998;51:186-190.

Lee B, Bickel K, Levin S. Microsurgical reconstruction of extensive scalp defects. J Reconstr Microsurg. 1999;15:255-64.

Pennington DG, Stern HS, Lee KK. Free-flap reconstruction of large defects of the scalp and calvarium. Plast Reconstr Surg. 1989;83:655-61.

Shonka DC, Potash AE, Jameson MJ, Funk GF. Successful reconstruction of scalp and skull defects: lessons learned from a large series. Laryngoscope. 2011;121:2305-12.

Hussussian CJ, Reece GP. Microsurgical scalp reconstruction in the patient with cancer. Plast Reconstr Surg. 2002;109:1828-34.

Newman MI, Hanasono MM, Disa JJ, Cordeiro PG, Mehrara BJ. Scalp reconstruction: a 15-year experience. Ann Plast Surg. 2004;52:501-6.

Lee S, Rafii AA, Sykes J. Advances in scalp reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2006;14:249-53.

Kazanjian VH, Holmes EM. Reconstruction after radical operations for osteomyelitis of the frontal sinus. Surg Gynecol Obstet. 1944;79:397.

McLean DH, Buncke HJ. Autotransplant of omentum to a large scalp defect, with microsurgical revascularization. Plast Reconstr Surg. 1972;49(3):268-74.

Lee JC, Kleiber GM, Pelletier AT, Reid RR, Gottlieb LJ. Autologous immediate cranioplasty with vascularized bone in high-risk composite cranial defects. Plast Reconstr Surg. 2013;132(04):967-75.

Ito E, Watanabe T, Sato T, Ichikawa M, Keiko O, Matsumoto Y, et al. Skull base reconstruction using various types of galeal flaps. Acta Neurochir (Wien). 2012;154:179-85.

Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plast Reconstr Surg. 2005;116(4):54e-72e.

Ibhler N, Ziegler MC, Penna V, Eisdenhardt SU, Stark GB, Bannasch H. An algorithm for oncologic scalp reconstruction. Plast Reconstr Surg. 2010;126 (2):450-9.

Beasley NJ, Gilbert RW, Gullane PJ, Brown DH, Irish JC, Neligan PC. Scalp and forehead reconstruction using free revascularized tissue transfer. Arch Facial Plast Surg. 2004;6(1):16-20.

Desai SC, Sand JP, Sharon JD, Branham G, Nussenbaum B. Scalp reconstruction: an algorithmic approach and systematic review. JAMA Facial Plast Surg. 2015;17:56-66.

Tepavicharova-Romanska P, Zaiakova I, Iankov D, Romanski R. Reconstruction of the large defects of the scalp with local fastiocutan flaps. Khirurgiia (Sofiia). 2004;60:16-9.

Lesavoy MA, Dubrow TJ, Schwartz RJ, Wackym PA, Eisenhauer DM, McGuire M. Management of large scalp defects with local pedicle flaps. Plast Reconstr Surg. 1993;91:783-90.

Nagasao T, Horiguchi T, Miyamoto J, Kishi K. Reconstruction of the scalp with a calvarial defect. Surg Today. 2011;41:189-96.

Costa DJ, Walen S, Varvares M, Walker R. Scalp rotation flap for reconstruction of complex soft tissue defects. J Neurol Surg B Skull Base. 2016;77(1):32-7.

Cecchi R, Bartoli L, Brunetti L, Troiano G. Double hatchet flap for scalp defect reconstruction. J Cutan Aesthet Surg. 2016;9(1):45-7.

García del Campo JA, García de Marcos JA, Del Castillo Pardo de Vera JL, García de Marcos MJ. Local flap reconstruction of large scalp defects. Med Oral Patol Oral Cir Bucal. 2008;13(10):E666-70.

Fincher EF, Gladstone HB. Dual transposition flaps for the reconstruction of large scalp defects. J Am Acad Dermatol. 2009;60(6):985-9.

Kim SW, Kim YH, Kim JT. Successful treatment of large forehead defect after the failure of tissue expansion: changing plan and strategy. J Craniofac Surg. 2011;22:2129-31.

van Driel AA, Mureau MA, Goldstein DP, Gilbert RW, Irish JC, Gullane PJ, et al. Aesthetic and oncologic outcome after microsurgical reconstruction of complex scalp and forehead defects after malignant tumor resection: an algorithm for treatment. Plast Reconstr Surg. 2010;126(2):460-70.

Chang KP, Lai CH, Chang CH, Lin CL, Lai CS, Lin SD. Free flap options for reconstruction of complicated scalp and calvarial defects: report of a series of cases and literature review. Microsurgery. 2010;30(01):13-8.

Zhou Y, Jiang Z, Li C, Cai Y, Sun R, Shui C, et al. An algorithm for one-stage malignant oncologic scalp reconstruction. Ann Transl Med. 2020;8(7): 432.






Original Research Articles