The secondary surgeries after unfavorable results in scalp defects treatment

The unfavorable results in scalp defects treatment are represented essentially by: local flap necrosis; cicatricial alopecia - calvarial contour defects; wide and poorly positioned scalp's scars. The secondary surgeries dealing with the new scalp defect (necrosis or alopecia) include: readvancement of prior flaps-raising a new local flap-tissu expansion - skin grafts - free flaps, bringing skin, muscle or vascularized bone. Their indications depend on the size of this defect, the presence of pericranium, the vascular condition of the scalp and the general condition of the patient. The secondary calvarial reconstructions are regularly done by altoplastic techniques, but sometimes autologous techniques are used. The presence of well vascularized skin coverage and the absence of local infection are mandatory before this cranioplasty. The scalp's scars can be effectively camouflaged by the classical hair minigrafting techniques. Certain principles must be applied to avoid these unfavorable results: one large axial rotation or transposition flap is better than multiple flaps and numerous scalp incisions, particularly for the beginners; hair growth can hide easily the scars when local flaps are well designed; excessive tension during local flaps closure must be avoided; galeal scoring and skin grafting of the donor site of these flaps are useful for that purpose; secondary tissue expansion can resolve many problems if the design of prior local flaps is correct; primary cranioplasty must be avoided if there is a risk of contamination; when the general condition of the patient is bad, treatment of such defects with simple methods is preferable. (C) 2019 Elsevier Masson SAS. All rights reserved.