Single Stage Scalp Reconstruction Utilizing Peri-cranial Rotational Flaps: A Case Series

Submitted by:

Christina Palomo MD
The Univeristy of Florida, department of Otolaryngology Head and Neck Surgery


Christina Palomo, MD


Background: The incidence of skin cancer is rapidly increasing. With the general population living longer, providers are seeing an increase in scalp defects due to cutaneous malignancies. The resulting defects after skin cancer excision can cause significant functional and aesthetic complications. We describe a single staged technique for scalp reconstruction in three medically complex patient’s. This technique aims to cover exposed calvarium with soft tissue and restore soft tissue contour while minimizing anesthesia risks and donor site morbidity.

Methods: Two patients with recurrent squamous cell carcinoma of their scalp previously treated with wide local excision, local flap reconstruction and radiation therapy, underwent re-excision with outer table craniectomy, single staged peri-cranial rotational flaps, and split thickness skin grafts. Another patient with a recent diagnosis of cutaneous clear cell carcinoma underwent the same surgery for a large scalp defect following cancer resection. Peri-cranial rotational flaps were designed to cover exposed calvarium defects. Flaps were approximated with resorbable suture and a split thickness skin graft harvested from the anterior thigh was sutured over the defect.

Results: Surgical wounds were well healed at initial post-operative visit and both split thickness skin grafts were noted to have 100% integration. All patient’s continued to show excellent healing results during long-term follow up.

Conclusions: Single stage scalp reconstruction utilizing peri-cranial rotational flaps is an effective reconstruction option for large scalp defects with exposed calvarium, most commonly seen with advanced or recurrent cutaneous carcinoma. This reconstructive option minimizes anesthesia risks and significant donor site morbidity, making it an appealing alternative in medically complexed patient’s.


Summarize the incidence of skin cancer on the aging population.

Demonstrate three medically complex cases of cutaneous malignancy resulting in large scalp defects following cancer resection

Describe a single staged reconstructive technique for large scalp defects in medically complexed individuals