title: Achievements in scalp reconstruction.
abstract: OBJECTIVE
  Reconstruction of scalp defects remains a challenge. This article reviews the reconstructive options and provides recommendations for scalp restoration based on current literature.
  
  
  RESULTS
  It is difficult to apply the standard reconstructive ladder to scalp defects due to the scalp's unique properties and paucity of adjacent tissue. Because of the frequency of large resections and the limited local tissue options microvascular free tissue transfer is a mainstay in scalp reconstruction and has been shown to be well tolerated and reliable with acceptable cosmetic and functional results. With advances in both surgery and anesthesia, increasing numbers of patients are candidates for free tissue transfer. The latissimus dorsi flap is a fundamental flap in scalp reconstruction. Recently, use of the anterolateral thigh (ALT) flap has risen. The radial forearm (RFF) free flap is also an extremely reliable, thin flap with great pedicle length well suited for the restoration of scalp contouring.
  
  
  CONCLUSIONS
  Microvascular free tissue transfer provides well tolerated, reliable, functional and cosmetically pleasing scalp restoration in a single surgery. The latissimus dorsi flap, ALT flap and RFF are the three most utilized free tissue options.
authors: Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, Washington, USA.
authors: Nicole M
authors: NM
authors: Fowler
authors: Neal D
authors: ND
authors: Futran
mesh_terms: D004954:Esthetics; D006801:Humans; D008866:Microsurgery; D019651:Plastic Surgery Procedures; D012535:Scalp / Q000601:surgery*; D016038:Skin Transplantation; D013524:Surgical Flaps; D015626:Tissue Expansion