Abstract
Scalp reconstruction, particularly with complex defects and infection risks, often
favors microvascular free flaps. However, this method can result in unavoidable alopecia
and undesirable aesthetics. This report describes a novel case where hair transplantation
via follicular unit extraction (FUE) was applied to a free myocutaneous flap. A 44-year-old
woman with Moyamoya disease suffered intracerebral hemorrhage a decade ago. Craniotomies
and autologous bone cranioplasties led to wound dehiscence, with subsequent failed
local flaps and skin grafts, and identification of a methicillin-resistant Staphylococcus aureus infection. The final scalp defect, measuring 13 × 9 cm, was reconstructed using a
free myocutaneous latissimus dorsi flap. Nine years post-surgery, a 1,500-unit FUE
hair transplantation procedure was conducted. The transplanted hair exhibited robust
survival with adequate blood supply, achieving a satisfactory 80 to 85% survival rate
at 12 months. This resulted in a notable improvement in the patient's external alopecia,
with reported high levels of satisfaction. Free flaps offer a valuable method for
scalp defect reconstruction; however, they may not ensure optimal aesthetic satisfaction
due to alopecia. Nonetheless, successful FUE hair transplantation on a myocutaneous
free flap can yield satisfactory aesthetic results.
Keywords baldness - scalp - free flap - reconstructive surgery
