[Reconstruction of the large scalp defect by free flap transplantation]

The reconstruction of a large scalp defect is extremely difficult on many occasions and repeated operations or a long-term hospitalization is often required. In addition, unsatisfactory results are not unusual. However, it is now possible to perform reconstruction by a one-stage operation of free tissue transplantation (free flap) using microsurgical vascular anastomosis which has rapidly developed in the past ten years. We performed reconstructions applying latissimus dorsi musculocutaneous, greater omentum, groin and scapular flaps. The advantages with the free flap are: (1) one-stage reconstruction is possible; (2) no restrictions on the postoperative position, (3) the flap, which is independent of the blood supply from the recipient, well survives on the recipient with an insufficient blood supply and (4) the damage at the donor site can be minimized. On the other hand, its disadvantages are as follows: (1) the operation requires microsurgical vascular anastomoses; and (2) recipient vessels should be normal. The above report was based on favorable results we obtained in 6 cases of reconstruction with free flap applying microvascular techniques.