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Brawley et al. Plast Aesthet Res 2022;9:6 https://dx.doi.org/10.20517/2347-9264.2021.107 Page 7 of 14

Figure 6. Defect of the anterior scalp and forehead.

Figure 7. H-flap used for a large, midline anterior scalp/forehead defect. Scarring reflected natural resting skin tension lines, and
eyebrow symmetry was not distorted (note: digital presurgical markings were added to the leftmost picture).

temporoparietal fascia overlying the deep temporal fascia. The dimensions of the flap can reach up to 4 to
5 cm in width and 24 to 26 cm in length . Careful surgical planning with arterial tracing via doppler and
[39]
palpation is recommended. The Juri flap has the advantage of a robust vasculature and hair-bearing tissue
transfer. It can also be used for free tissue transfer .
[40]
Occipital scalp defects
Defects and repairs of the occiput have the advantage of easier camouflage with long hair [Figure 8]. In
addition, patients are less cosmetically sensitive to this area since it is not routinely visualized by them. The
occipital scalp has moderate skin laxity with the advantage of posterior cervical tissue for advancement
purposes. Defects ranging from 2-4 cm in diameter can be closed primarily with circumferential
undermining.

Posterior cervical rotation flaps are the workhorse for medium-sized occipital scalp defects. Due to the
contour of the scalp, longer incisions for rotational flaps may be needed, with some literature citing a length
up to 6 times the greatest diameter of the defect [41,42] . The anterior cervical rotation flap has been used to
[43]
repair midface defects due to its high success rate and excellent color and texture match . Similarly, we