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Free Flap Reconstruction Following Mohs Surgery: Our Approach to Complex Skin Cancer on the Scalp
Ayaka Nochi Deguchi1,2, Niv Milbar1, Andrew Pregnall1
1Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
Journal of Reconstructive Microsurgery
|September 17, 2025
Summary
Free flap reconstruction effectively treats complex scalp defects after Mohs surgery (MMS). Highly complex defects increase risks of delayed healing and dehiscence, emphasizing surgeon collaboration for optimal outcomes.
Area of Science:
- Plastic Surgery
- Dermatologic Surgery
- Microsurgery
Background:
- Scalp reconstruction after Mohs micrographic surgery (MMS) is challenging for complex defects.
- Free flap reconstruction offers a viable solution for optimal coverage in these cases.
Purpose of the Study:
- To evaluate free flap reconstruction for complicated scalp defects post-MMS.
- To identify risk factors associated with complications in these reconstructions.
Main Methods:
- Retrospective chart review of 56 patients undergoing free flap scalp reconstruction (March 2010-June 2024).
- Analysis of demographics, comorbidities, defect complexity (radiation, size, depth, implants), and outcomes.
- Multivariate and comparative analyses to identify risk factors.
Main Results:
- Sixty free flaps (anterolateral thigh and latissimus dorsi common) were analyzed.
- Age and BMI correlated with higher complication rates.
- Highly complex defects significantly increased risks of delayed wound healing and dehiscence.
Conclusions:
- Free flap reconstruction is an effective treatment for complex scalp defects following MMS.
- Surgeon collaboration is crucial for managing challenging scalp defects and optimizing patient outcomes.
