[Dermatologic surgery on the scalp].

Soft tissue defects of the scalp can be closed with varying techniques depending on size and depth of the defect. While small and superficial defects can be closed primarily or be left open for secondary intention healing, larger and deeper defects may need flaps or skin grafts. Extensive defects may require combined flaps or vacuum assisted closure techniques. Defects of the periosteum with denuded skull bone must be treated immediately to avoid bony complications. Usually, the tabula externa is fenestrated with holes or abraded totally to create better healing conditions. Granulation tissue may be induced on the properly prepared skull with vacuum-assisted closure, by using collagen sheets or with dermal skin substitutes. New developments in tissue engineering will surely provide new techniques for dealing with deep and extensive soft tissue defects.