Salvaging Defects: Scalp Flap as a Rescue Approach in Complex Head and Neck Reconstructive Procedure

Oral cancer is a significant global health concern, ranking as the sixth most common cancer worldwide, and is the most prevalent cancer among men in India. Treatment often involves multimodal approaches, with surgical resection being primary. Complex reconstructive challenges arise in cases of recurrence, flap failure, osteoradionecrosis (ORN), or when traditional flap options are exhausted. The scalp flap, with its rich vascularity and robust axial supply from the superficial temporal artery, offers a viable salvage option for head and neck reconstruction. This retrospective study evaluated oral cancer patients treated between February 2020 and February 2025. Scalp flaps were used in 21 male patients for salvage reconstruction in cases involving recurrence, flap necrosis, skin loss, or ORN. Flaps were planned with Doppler mapping, elevated in the subgaleal plane, and inset into the defect. Donor sites were managed with split-thickness skin grafts. All 21 patients underwent successful scalp flap reconstruction for various oral subsites, including the buccal mucosa, lower gingivobuccal sulcus, floor of mouth, and lip. Prior reconstructions included PMMC, submental, ALT, and fibula flaps. The scalp flap provided effective coverage with satisfactory outcomes in function and contour restoration, especially where previous flaps had failed or were not viable. The scalp flap is a reliable, well-vascularized salvage option in complex oral cancer reconstructions, particularly in post-radiation and recurrent settings. Despite aesthetic limitations and the need for a two-stage procedure, its anatomical and vascular properties make it a valuable alternative when conventional options are not feasible.