Keepin It Local: Mastering Local Flaps for Scalp Reconstruction (2024 AMW)

The utilization of local scalp flaps for reconstruction of moderate- to large-sized scalp defects has often been associated with wound breakdown, infection, and tissue necrosis. This is in large part due to the unyielding convexity of the skull, limited vascularity of the scalp, and limited elasticity of scalp tissue. Yet with proper patient selection, flap design, and intraoperative techniques, local scalp flaps offer reliable and excellent outcomes. Benefits of local scalp flaps for patients include: 1) no major donor site morbidity, 2) shorter operative times, and 3) minimal to no post-operative hospitalization. Given the rising incidence of skin cancers (many of which are located on the scalp) and an increasingly aging and comorbid population, the benefits of local scalp flaps are striking and real. However, with the increasing reliability and efficiency of microvascular free tissue transfer, it is not surprising that many surgeons have pivoted to primarily using free flaps to reconstruct most scalp defects. This has resulted in a growing unfamiliarity with local scalp flaps and a lack of comfort using such flaps by many attending surgeons and trainees. The goals of this session are to dispel the negative myths surrounding local scalp flaps and foster confidence for surgeons to offer this type of reconstruction in the correct patient population. Multiple local scalp flap designs, an algorithm for using local scalp flaps, and technical pearls for success will be discussed. For the microvascular surgeon who wishes to broaden their reconstructive repertoire, this session will provide the familiarity, knowledge base, and tips to add local scalp flaps to their armamentarium. For the non-microvascular surgeon who wishes to provide excellent reconstructive care without having to refer patients to other providers or centers, this session will discuss patient selection and the range of defects in which local scalp flaps are reliable and effective.