Optimising Aesthetic Reconstruction of Scalp Soft Tissue by an Algorithm Based on Defect Size and Location

Introduction: Scalp soft tissue defects are common and result from a variety of causes. Reconstructive methods should maximise cosmetic outcomes by maintaining hair-bearing tissue and aesthetic hairlines. This article outlines an algorithm based on a diverse clinical case series to optimise scalp soft tissue coverage. Materials and Methods: A retrospective analysis of scalp soft tissue reconstruction cases performed at the Singapore General Hospital between January 2004 and December 2013 was conducted. Results: Forty-one patients were included in this study. The majority of defects <100 cm(2) were reconstructed with local flaps and were subdivided by location. Methods included rotation, transposition and free flaps. The most common type of reconstruction performed for defects >= 100 cm(2) was free flap reconstruction. Multistage reconstruction using tissue expanders aided in optimising cosmetic outcomes. There were no major complications or flap failures. Conclusion: By analysing our experience with scalp softtissue reconstruction, we have developed an algorithm based on defect size and location, achieving excellent closure and aesthetic outcome while minimising complications and repeat procedures.