Abstract We present the case of a 73-year-old female with two squamous cell carcinoma lesions on the left scalp: a 3.0 cm × 2.1 cm lesion on the superior parietal region and a 6.0 cm Å~ 2.7 cm carcinoma in situ on the frontal region. Following Mohs micrographic surgery (MMS), the defects required reconstructive closure due to their large size and the patient’s desire for hair-bearing skin. A staged approach was used, involving debridement, wound matrix placement (Matriderm and Integra), and a split-thickness skin graft. To address the large defect and preserve hair-bearing tissue, tissue expanders were placed in the subgaleal plane, and gradual expansion was performed over three months. Once adequate tissue expansion was achieved, a bilateral rotation flap was performed, utilizing the expanded tissue to close the defects. The final flap dimensions were 22 cm × 22 cm, resulting in a well-contoured scalp with full hair regrowth. At 6-month follow-up, the patient reported an excellent cosmetic result with no complications. This case highlights the effectiveness of tissue expansion and bilateral rotation flaps for large scalp defects after MMS, particularly when hair-bearing tissue is a priority. The successful outcome emphasizes the importance of a multidisciplinary approach to managing complex scalp reconstructions.
Russell et al. (Tue,) studied this question.