Immediate total scalp and skull reconstruction.

A patient who required excision of a large basal cell carcinoma was left with a scalp defect measuring 23 cm x 23 cm, associated with an underlying bony defect of 18 cm x 16 cm with a similar dural defect. Simultaneous reconstruction of all three layers was performed using a large free latissimus dorsi flap, titanium strips, and lumbar fascia. A satisfactory cosmetic and functional result was obtained using this technique.