Reconstruction for large defects of the scalp and cranium.

Thirty-one patients with large scalp and cranium defects were reconstructed with free tissue transfer and scalp flaps. Twenty-eight of the defects resulted after tumour resection, two after infection and one after an extensive burn. Thirty-one free flaps (mainly the latissimus dorsi myocutaneous and the radial forearm fasciocutaneous) and five large (> 200 cm2) scalp flaps were used. Major complications occurred in one patient who developed meningitis and finally died (3.2%), and in one patient who lost a latissimus dorsi flap (3.2%). There were no other significant problems with the remaining patients. All other free flaps and scalp flaps survived. Primary reconstruction with free tissue transfer was our first choice of treatment because of the wide spectrum of advantages of free flaps. However, in a limited number of cases there was an indication for large scalp flaps, which, when properly designed, gave satisfactory results.