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Pedicled Scalp Reconstruction After Radiation Therapy.

Jolly S Grewal1, Malek H Bouzaher, Giovanni P Ortiz

  • 1Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX.

The Journal of Craniofacial Surgery
|May 4, 2026
PubMed
Summary

Pedicled scalp flaps are a reliable option for reconstructing large scalp defects in patients with prior radiation therapy. A history of previous scalp flaps increases the risk of complications.

Keywords:
Cranioplastyexposed calvariumpedicled flapradiated defectscalp reconstruction

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Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Oncology

Background:

  • Reconstructing large scalp defects after external beam radiation therapy (EBRT) is challenging due to compromised vascularity and poor healing.
  • Pedicled scalp flaps offer a potentially simpler alternative to free tissue transfer for selected patients.
  • This study evaluates pedicled scalp flap outcomes in irradiated patients with significant scalp defects.

Purpose of the Study:

  • To assess the reliability of pedicled scalp flaps for large scalp defect reconstruction in patients with prior EBRT.
  • To identify risk factors associated with pedicled scalp flap complications in this patient population.

Main Methods:

  • Retrospective review of 216 patients treated between January 1998 and December 2024.
  • Inclusion criteria: prior EBRT, scalp defect size ≥15 cm², pedicled scalp flap use, and ≥6 months follow-up.
  • Data collected: demographics, prior surgeries, reconstruction indications, flap design, complications, survival, and reoperations.

Main Results:

  • Complete healing occurred in 87.5% of patients (189/216).
  • Complications included wound breakdown (16 patients), partial flap loss (8 patients), and major flap loss (3 patients).
  • A history of prior scalp flaps was associated with increased risk of partial or major flap loss.

Conclusions:

  • Pedicled scalp flaps are a reliable reconstructive choice for large defects in irradiated patients when vascular principles are respected.
  • Prior scalp flap history is a significant risk factor for flap loss and should guide surgical planning.
  • These findings support the use of pedicled scalp flaps in this challenging patient group.