[The impact of the VAC-treatment for locally advanced malignancy of the scalp].

Locally advanced cutaneous malignancy of the scalp is a disease that requires an aggressive approach to resection and reconstruction. In cases where the pericranium is intact a split-thickness skin graft is a simple treatment, since direct closure often fails because due to the lack of elasticity of the scalp. If there is a loss of periosteum or a skull defect local or free flaps are necessary for sufficient coverage. Increasing geriatric and polymorbid patients with impaired wound healing require surgical treatment, considering pros and cons for general anaesthesia. A simple method of both, combining radicality of tumor resection with outer table bone and skin grafting as a two stage procedure, while minimizing perioperative risk using local anaesthesia and analgo-sedation, using the vacuum assisted closure device, is presented.