Galeal-occipitalis flap for reconstruction of post-oncologic defects of the lateral scalp

Scalp and/or calvarial defects can occur after tumor excision, trauma, burns, radiation therapy and infection. Reconstruction after tumor resection may involve soft tissues of the scalp, calvarial bone and meningeal membranes. An 86-year-old man was referred to us with an extensive 22x12 cm dirty ulcerative recurrence of basal cell carcinoma involving the fronto-parietal scalp and previously treated by dermatologist with incomplete excision and photodynamic therapy. A posteriorly pedicled flap, based on the occipital artery and vein and branches of the posterior auricular artery and vein, was elevated in a supraperiosteal plane. It consisted of skin, subcutaneous tissue, galea and part of the loose subgaleal tissue and was approximately 25x15 cm wide, providing adequate coverage to the ablative defect. Split-thickness skin grafts from the anterior thigh were employed to cover the donor pericranium. Postoperatively, distal necrosis of the flap did not occur and the skin grafts survived. One year after the operation the patient is clinically free of tumor recurrence and satisfied with the surgical result. Our experience shows the possibility to cover large scalp defects with a rotation scalp flap based on one major vessel. Due to the anastomoses between vessels of different angiosomes, in our case the anterior scalp was vascularised directly by the occipital artery and vein.