Scalp reconstruction after squamous cell carcinoma resection: A case report

Cutaneous squamous cell carcinoma (cSCC) of the scalp poses significant reconstructive challenges due to limited tissue mobility, convex bony anatomy, and a scarcity of adjacent donor tissue. Surgical excision remains the primary treatment but may result in extensive defects requiring advanced reconstruction strategies.

We report the case of a patient presenting with a necrotic scalp lesion diagnosed as infiltrative cSCC near the vertex, extending to the right parietal region, with a preoperative tumor size of approximately 6 cm × 4 cm. Wide local excision with 1.0-1.5 cm margins was performed, followed by intraoperative frozen section confirmation of tumor-free margins. The resulting full-thickness defect, measuring approximately 8 cm × 6 cm and exposing the calvarial bone, was reconstructed using five pinwheel flaps to redistribute local scalp tissue. This approach achieved complete coverage, preserved contour, and enabled a single-stage reconstruction without the need for free flaps or dermal substitutes.

This case demonstrates the effectiveness of employing five pinwheel flaps for reconstructing a complex, full-thickness scalp defect in a patient with adequate local tissue reserves, offering a tissue-sparing alternative to more invasive methods like free tissue transfer or dermal templates. The technique, supported by preoperative planning and intraoperative margin assessment, ensured oncologic safety and aesthetic restoration while minimizing morbidity. The unique application of five pinwheel flaps in this large defect highlights a less commonly utilized approach, providing an educational example of adaptability in challenging cases.

The use of five pinwheel flaps provides a viable, single-stage option for reconstructing full-thickness scalp defects following cSCC resection, particularly in cases with sufficient local tissue. This report contributes to the surgical literature by expanding the application of pinwheel flaps, demonstrating their potential in complex scalp reconstruction, and emphasizing their role in multidisciplinary reconstructive planning.