• Vol. 44 No. 11, 535–541
  • 15 November 2015

Optimising Aesthetic Reconstruction of Scalp Soft Tissue by an Algorithm Based on Defect Size and Location

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ABSTRACT

Introduction: Scalp soft tissue defects are common and result from a variety of causes. Reconstructive methods should maximise cosmetic outcomes by maintaining hair-bearing tissue and aesthetic hairlines. This article outlines an algorithm based on a diverse clinical case series to optimise scalp soft tissue coverage.

Materials and Methods: A retrospective analysis of scalp soft tissue reconstruction cases performed at the Singapore General Hospital between January 2004 and December 2013 was conducted.

Results: Forty-one patients were included in this study. The majority of defects <100 cm2 were reconstructed with local flaps and were subdivided by location. Methods included rotation, transposition and free flaps. The most common type of reconstruction performed for defects ≥100 cm2 was free flap reconstruction. Multistage reconstruction using tissue expanders aided in optimising cosmetic outcomes. There were no major complications or flap failures.

Conclusion: Forty-one patients were included in this study. The majority of defects <100 cm2 were reconstructed with local flaps and were subdivided by location. Methods included rotation, transposition and free flaps. The most common type of reconstruction performed for defects ≥100 cm2 was free flap reconstruction. Multistage reconstruction using tissue expanders aided in optimising cosmetic outcomes. There were no major complications or flap failures.


Full-thickness scalp soft tissue defects are common and causes include trauma, tumour resection, radiation necrosis and infection. The need for adequate coverage is important as the scalp provides protection to underlying structures such as the calvarium, meninges and brain parenchyma. Poor decision-making in reconstructive choice can lead to wound breakdown, repeated operations, exposed implants and patient distress. Factors such as a previously irradiated or infected field increase these risks.

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