Recurrent squamous cell carcinoma of the scalp treated with serial free flaps: A case report

Reconstruction of large full thickness scalp defects is always a challenge. Many different techniques can be used, but larger defects often call for a free tissue transfer. The purpose of this report is to present one successful way of treating multiple large scalp defects. A 61-year-old man was seen with recurrent squamous cell carcinoma of the scalp. The lesions were of full thickness, about 10-15 cm in diameter and included the calvarial bone and the dura layer. The reconstruction process included split-thickness skin grafting, local flaps, and three free microvascular flaps; two latissimus dorsi flaps and one anterolateral thigh flap. No total flap loss was seen, but partial flap necrosis called for secondarily reconstruction. The final result was cosmetically acceptable and the patient is of good health. In conclusion, serial free microvascular flaps may be used with good results when dealing with large difficult and recurrent scalp defects.