Original ArticlesFree Flaps in the Treatment of Locally Advanced Malignancy of the Scalp and ForeheadMcCombe, D. FRACS; Donato, R. FRACS; Hofer, S. MD; Morrison, W. MD, FRACS Author Information From the Department of Surgery and the Plastic and Reconstructive Surgery Unit, St Vincents Hospital, Melbourne, Australia. Received Oct 10, 2001. Accepted for publication Nov 1, 2001. Address correspondence and reprint requests to Dr Morrison, Department of Surgery, St Vincent’s Hospital, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia. McCombe D, Donato R, Hofer S, Morrison W. Free flaps in the treatment of locally advanced malignancy of the scalp and forehead. Annals of Plastic Surgery: June 2002 - Volume 48 - Issue 6 - p 600-606 Buy Abstract Locally advanced cutaneous malignancy of the scalp and forehead is a disease that requires an aggressive approach to resection and reconstruction. Free flap reconstruction in these sites has been advocated because of the advantages of importing large amounts of well-vascularized tissue into a recipient site, which has often been compromised by previous surgery or radiotherapy. A consecutive series of 32 free flap reconstructions in 29 patients with cutaneous malignancy of the scalp and forehead was reviewed. The flap failure rate was 6% (two flaps) and the major complication rate was 10%. Of the surviving flaps, 97% (N = 29) were successful in reconstructing a challenging group of defects. Three patients developed local recurrence of the primary malignancy (mean follow-up, 21 months). The use of a broad repertoire of free tissue transfers in reconstruction of the scalp and forehead defects has allowed effective treatment of locally advanced malignancy of this region. Critical analysis of the results, however, indicates that microsurgical reconstruction is not without morbidity and that there are refinements in the diagnostic and operative steps of management that can maximize the functional and aesthetic results. © 2002 Lippincott Williams & Wilkins, Inc.