Technical Nuances During Reconstruction of a Complex Scalp Defect: a Pictorial Essay

Scalp region is a common site of cutaneous squamous cell carcinoma (SCC). Surgical excision with reconstruction is the primary treatment. Lesions that infiltrate the dura resulting in large composite defects pose technical challenge. A 53-year-old gentleman presented with an ulcero-proliferative growth on the scalp. Imaging revealed an 8 × 7 cm mass on the left temporo-parietal region, breaching calvarium and infiltrating dura. The biopsy was suggestive of SCC. Resection resulted in a large composite scalp defect which was reconstructed with tensor fascia lata, titanium mesh and occipital artery-based transposition flap. We highlight the technical intricacies that need consideration and optimum reconstruction options for composite scalp defects. An occipital artery-based flap is a technically easy and reliable option with satisfactory aesthetic outcomes. Enhanced post-operative recovery and adequate defect coverage permit timely adjuvant treatment.