Abstract
Background Microsurgical scalp reconstruction has evolved immensely in the last half-century.
The core concepts of microsurgical scalp reconstruction have always been to transfer
soft tissue of a sufficient quality to within the defect while minimizing donor site
morbidity. Refinements in scalp reconstruction consist of both improvement in reducing
donor site morbidity and enhancing recipient site contour and balance. Furthermore,
technical advancements and the vast experience within our field have allowed for preoperative
evaluation of recipient vessels that are more favorable in proximity to the scalp.
Methods In this review, we aim to describe the contemporary approach to microsurgical scalp
reconstruction. This is to include the indications of choosing free flaps as well
as how to select the ideal flap based on patient-oriented factors. The need for cranioplasty,
recipient vessel selection, operative technique, and reoperations is also reviewed.
In addition, our considerations and the nuances within each category are also described.
Summary Scalp reconstructions involve the fundamental tenants of plastic surgery and demand
application of these principles to each case on an individual basis and a successful
reconstruction must consider all aspects, with backup options at the ready. Two workhorse
free flaps, the anterolateral thigh perforator and latissimus dorsi muscles flaps,
serve a primary role in the contemporary approach to microsurgical scalp reconstruction.
Conclusion We hope this review can lay the foundation for which future plastic surgeons may
continue to build and advance the approach to complex microsurgical scalp reconstruction.
Keywords
scalp reconstruction - microsurgery - free tissue transfer - contemporary approach
- recipient vessels - cranioplasty
