Objective To examine the indications for, and the success of, free flap reconstruction in patients with forehead and scalp defects.
Design Case series.
Setting Two tertiary referral university teaching hospitals.
Patients Twenty-six consecutive patients, aged 31 to 85 years, presenting with 26 scalp defects, 5 forehead defects, and 1 combined defect (size, 70-672 cm2). Three patients required resection and repair of the dura at surgery.
Intervention Patients were staged according to the size of the defect and the viability of surrounding tissue; free flap reconstruction was performed where indicated.
Main Outcome Measures Flap survival, complications, and disease-free and overall survival.
Results Thirty-four free flap reconstructions were performed (24 latissimus dorsi free flaps, 4 scapular free flaps, 3 rectus abdominis free flaps, and 3 radial forearm free flaps). One failed 2 weeks postoperatively, and 2 required exploration (1 for arterial ischemia and 1 for a hematoma). There were 3 cases of donor site morbidity (2 early seromas and 1 late abdominal hernia). One patient died of a pulmonary embolus 1 week postoperatively. Disease-free survival was 48% at 5 years and overall survival was 59% at 5 years, with a median follow-up of 24 months.
Conclusions Free revascularized tissue transfer is a reliable and safe way of reconstructing large scalp or forehead defects after traumatic injury or neoplastic resection. The muscle-only latissimus dorsi free flap for scalp reconstruction and the cutaneous scapular free flap for the forehead have proved successful in selected patients with a low complication rate and satisfactory cosmesis.