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

Figure 9. Posterior cervical rotation flap with flap limb designed along the hairline.

Figure 10. Defects of the temporoparietal scalp (note: these images have been slightly altered to remove presurgical markings).

2
Other suitable options for medium-sized defects up to 25 cm in this area include V-Y flaps, rhomboid flaps,
and bilobed flaps. For larger defects, tissue expansion will yield the best cosmetic outcomes .
[51]
TISSUE EXPANDERS
In larger defects where hairline distortion is likely with local flaps, a tissue expander should be considered.
This is a staged operation that requires thorough patient communication and reliability, with an
understanding that unsightly tissue expansion in the short term may give rise to the patient’s best ultimate
cosmetic outcome [Figure 13]. Close follow-up and risk/benefit counseling should be discussed with each
patient.

[52]
Tissue expanders have been reported to cover a 50% scalp defect adequately . Expanders are placed in the
subgaleal plane through a small incision at a perpendicular orientation. The expansion process is
recommended to begin between 7 and 14 days after implantation, as the galea loses its rigid, inelastic