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Brawley et al. Plast Aesthet Res 2022;9:6 Plastic and
DOI: 10.20517/2347-9264.2021.107
Aesthetic Research

Review Open Access

Scalp reconstructive flaps

Craig Cameron Brawley, Douglas Sidle
Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
60611, USA.

Correspondence to: Dr. Craig Cameron Brawley, Department of Otolaryngology-Head and Neck Surgery, Northwestern
University Feinberg School of Medicine, 675 N Saint Clair St, Fifteenth Floor, Suite 200, Chicago, IL 60611, USA.
E-mail: craig.brawley@northwestern.edu

How to cite this article: Brawley CC, Sidle D. Scalp reconstructive flaps. Plast Aesthet Res 2022;9:6.
https://dx.doi.org/10.20517/2347-9264.2021.107
Received: 26 Sep 2021 First Decision: 8 Nov 2021 Revised: 9 Nov 2021 Accepted: 14 Dec 2021 Published: 14 Jan 2022

Academic Editors: Matthew Spector, Mark K. Wax Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Scalp reconstruction requires keen insight into underlying anatomy and surgical armamentarium. The
reconstructive surgeon must consider a plethora of complexities to devise a safe and cosmetically maximized
outcome. The purpose of this article is to review scalp reconstruction techniques and the current literature in the
framework of the reconstructive ladder, with special emphasis on local flap consideration, design, and execution.

Keywords: Scalp reconstruction, scalp defects, local flaps, scalp flaps, reconstructive ladder

INTRODUCTION: SCALP COMPLEXITIES AND THE RECONSTRUCTIVE LADDER
There are many aspects of the scalp which make reconstruction difficult. The contour of the skull is
primarily convex but variable per region and patient. Although highly vascular, the layers of the scalp are
thick with an inelastic galea aponeurosis, limiting closure in certain areas. Additionally, the desire to save
the hair-bearing scalp and maintain the integrity of a patient’s hairline poses a unique cosmetic challenge.

Those challenges and others (i.e., the size of the defect, intact structures, history of radiation, etc.) have
propelled many to propose algorithms on how to approach scalp defects . While it is logical to have a
[1-8]
template of the many options available and a decision tree for complicating factors, a more realistic
approach involves the application of a reconstructive ladder [Figure 1]. Each step of the ladder represents

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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