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Achievements in scalp reconstruction

Fowler, Nicole M.; Futran, Neal D.

Current Opinion in Otolaryngology & Head and Neck Surgery: April 2014 - Volume 22 - Issue 2 - p 127–130
doi: 10.1097/MOO.0000000000000028
HEAD AND NECK ONCOLOGY: Edited by Piero Nicolai and Cesare Piazza

Purpose of review Reconstruction of scalp defects remains a challenge. This article reviews the reconstructive options and provides recommendations for scalp restoration based on current literature.

Recent findings It is difficult to apply the standard reconstructive ladder to scalp defects due to the scalp's unique properties and paucity of adjacent tissue. Because of the frequency of large resections and the limited local tissue options microvascular free tissue transfer is a mainstay in scalp reconstruction and has been shown to be well tolerated and reliable with acceptable cosmetic and functional results. With advances in both surgery and anesthesia, increasing numbers of patients are candidates for free tissue transfer. The latissimus dorsi flap is a fundamental flap in scalp reconstruction. Recently, use of the anterolateral thigh (ALT) flap has risen. The radial forearm (RFF) free flap is also an extremely reliable, thin flap with great pedicle length well suited for the restoration of scalp contouring.

Summary Microvascular free tissue transfer provides well tolerated, reliable, functional and cosmetically pleasing scalp restoration in a single surgery. The latissimus dorsi flap, ALT flap and RFF are the three most utilized free tissue options.

Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, USA

Correspondence to Neal D. Futran, MD, DMD, Allison T. Wanamaker Professor and Chair, Department of Otolaryngology-Head and Neck Surgery, University of Washington, 1959 NE Pacific Street, Box 356515, Seattle, WA 98195, USA. Tel: +1 206 543 8383; e-mail:

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