[Surgical wounds of the scalp. Methods of closure]

The reconstruction of scalp defects following tumor excisions can be a difficult surgical challenge. The size, location and the depth of the defect, but also the presence or absence of hair, the location of the hairline, the condition of the adjacent tissue and possible co-morbidities must be taken into account in order to choose an appropriate reconstructive technique. Even smaller defects often require local flaps and skin grafts. The increasing number of scalp tumors arising on the basis of actinic field cancerization often lead to large defects with exposed scalp bone. In this context flaps combined with split-thickness skin grafting of the donor site defect, granulation-inducing methods with second intention healing and the application of dermis equivalents are possible options to cover the exposed cranium. Adequate functional as well as aesthetic reconstruction of scalp defects require excellent understanding of the options and limits of the diverse closure techniques, good knowledge of the anatomy and proper preoperative planning.