title: Optimising Aesthetic Reconstruction of Scalp Soft Tissue by an Algorithm Based on Defect Size and Location.
abstract: BACKGROUND
  Scalp soft tissue defects are common and result from a variety of causes. Reconstructive methods should maximise cosmetic outcomes by maintaining hair-bearing tissue and aesthetic hairlines. This article outlines an algorithm based on a diverse clinical case series to optimise scalp soft tissue coverage.
  
  
  METHODS
  A retrospective analysis of scalp soft tissue reconstruction cases performed at the Singapore General Hospital between January 2004 and December 2013 was conducted.
  
  
  RESULTS
  Forty-one patients were included in this study. The majority of defects <100 cm² were reconstructed with local flaps and were subdivided by location. Methods included rotation, transposition and free flaps. The most common type of reconstruction performed for defects ≥100 cm² was free flap reconstruction. Multistage reconstruction using tissue expanders aided in optimising cosmetic outcomes. There were no major complications or flap failures.
  
  
  CONCLUSIONS
  By analysing our experience with scalp soft tissue reconstruction, we have developed an algorithm based on defect size and location, achieving excellent closure and aesthetic outcome while minimising complications and repeat procedures.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore.
authors.forename: Adrian Sh
authors.initials: ASh
authors.lastname: Ooi
authors.forename: Muholan
authors.initials: M
authors.lastname: Kanapathy
authors.forename: Yee Siang
authors.initials: YS
authors.lastname: Ong
authors.forename: Kok Chai
authors.initials: KC
authors.lastname: Tan
authors.forename: Bien Keem
authors.initials: BK
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004954:Esthetics; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000067029:Physical Appearance, Body; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012535:Scalp / Q000601:surgery*; D012846:Singapore; D012878:Skin Neoplasms / Q000601:surgery*; D012886:Skull / Q000601:surgery*; D013524:Surgical Flaps; D015625:Tissue Expansion Devices; D016896:Treatment Outcome