A critical appraisal of the use of free flaps in primary reconstruction of combined scalp and calvarial cancer defects.

Eleven patients had scalp tumours with full thickness calvarial invasion excised and reconstructed with free flap transfer as a primary procedure. Latissimus dorsi or radial forearm flaps were used, with split rib calvarial reconstruction. One flap was lost peroperatively and another necrosed at 8 days following pedicle compression against an acrylic "skull". Only six patients presently survive, two being treated for recurrence. Long-term follow-up indicates that poor prognostic factors are advanced local invasion, squamous or anaplastic tumours, and advanced age. However, palliative treatment has a role.