Surgical Outcomes After Scalp Reconstruction With Free Tissue Transfer

Complex scalp defects represent a significant reconstructive challenge and frequently require free tissue transfer. Although the latissimus dorsi (LD) and anterolateral thigh (ALT) flaps are widely regarded as preferred options, existing studies are limited by small sample sizes or short follow-up. This study reviews an 8-year institutional experience with scalp free flap reconstruction to inform best practices in managing complex scalp defects.

A retrospective review was conducted of a consecutive set of scalp reconstruction cases that required free tissue transfer between 2015 and 2023. Comorbidities, surgical details, and postoperative complications up to 90 days after surgery were noted. Standard descriptive analysis was performed.

The LD flap was the most frequently used flap, accounting for 45.2% (n = 14) of reconstructions, followed by the ALT flap in 35.5% (n = 11) of cases. Among LD flaps, hematoma was the most frequent 30-day complication, occurring in 35.7% (n = 5) of patients, and 1 patient (7.1%) experienced complete flap necrosis within 90 days. In the ALT group, wound dehiscence occurred in 27.3% (n = 3) of patients and hematoma in 18.2% (n = 2), representing the most common 30-day complications. No patients in the ALT group developed complete flap necrosis within 90 days. Across the entire cohort, the overall rate of complete flap necrosis at 90 days was 3.2% (n = 1).

Free flap reconstruction is an effective method for complex soft tissue scalp defects, although it carries associated morbidities. Understanding the risks and benefits of such procedures is crucial in patient education and shared decision-making.