Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
Send us all your questions or requests, and our expert team will assist you.
The most common indication for scalp reconstruction is the excision of malignant skin tumors. Basal Cell Carcinoma (BCC), Squamous Cell Carcinoma (SCC), and Melanoma frequently occur on the scalp due to high cumulative sun exposure, particularly in individuals with thinning hair.
These tumors often require wide margins of excision to ensure complete removal. Because the scalp skin is tight and inelastic, even relatively minor defects from cancer removal can be impossible to stitch closed directly. Reconstruction is required immediately following the cancer surgery (Mohs surgery or wide excision) to seal the wound.
Traumatic injuries, such as those from industrial accidents, car crashes, or animal attacks, can result in scalp avulsion. This is a devastating injury where the scalp is torn away from the skull, often exposing the periosteum or the bone itself. These injuries are surgical emergencies.
Reconstruction depends on the viability of the avulsed tissue. If the piece is preserved, microsurgical replantation is attempted. If not, the defect must be covered with flaps or grafts. The goal is to convert a contaminated, open wound into a closed, sterile environment to prevent osteomyelitis.
The scalp is a common site for high-voltage electrical burns, as the head is often the point of contact or exit for the current. Thermal burns from fire or chemicals also frequently affect the head. These injuries result in full-thickness necrosis (death) of the skin and often the underlying bone.
Burn reconstruction is challenging because the surrounding tissue may also be damaged or scarred. The dead tissue (eschar) must be aggressively removed (debrided). Reconstruction often involves multiple stages, initially using skin grafts and later tissue expansion to restore the hair-bearing scalp.
Congenital Melanocytic Nevi are large, pigmented birthmarks that can cover significant portions of the scalp. These pose a risk of malignant transformation into melanoma and are often cosmetically distressing. Aplasia Cutis Congenita is a condition where a baby is born with a missing patch of skin and bone on the scalp.
Surgical treatment typically involves serial excision (removing part of it at a time) or tissue expansion. The goal is to remove the abnormal tissue and replace it with normal, hair-bearing skin before the child reaches school age to minimize social stigma.
Patients who have undergone radiation therapy for brain tumors or scalp cancers often suffer from radiation necrosis. Radiation damages the DNA of the cells and the blood vessels (endarteritis), causing the skin to become thin, fibrotic, and unable to heal.
These wounds often break down spontaneously years after treatment, exposing the skull. Because the local tissue is compromised by radiation, local flaps usually fail. These cases frequently require the use of healthy, non-irradiated tissue from outside the zone of injury, often via free tissue transfer.
Scalp infections can occasionally progress to necrotizing fasciitis, a life-threatening bacterial infection that spreads rapidly along the galea plane. This condition requires aggressive emergency debridement, where large areas of infected scalp are surgically removed to save the patient’s life.
Once the infection is cleared and the patient is stable, they are left with a massive defect. Reconstruction is usually delayed until the wound bed is absolutely sterile. Skin grafting is a common first step to cover the large area, followed by complex rebuilding later.
Patients who have undergone neurosurgery often have titanium plates, screws, or custom cranioplasty implants (artificial skull pieces) implanted. If the scalp overlying these implants is thin or breaks down, the hardware becomes exposed.
Exposed hardware invariably becomes colonized by bacteria. Reconstruction is required to either remove the infected hardware or, if possible, salvage it by covering it with a thick, vascularized muscle flap. Thin skin grafts are insufficient to cover metal or plastic implants.
Chronic osteomyelitis is a persistent infection of the bone of the skull. It often results from a chronic scalp wound. The infected bone dies, forming a sequestrum (a dead piece of bone) that the body tries to reject.
Treatment involves a dual approach: the neurosurgeon removes the infected, dead bone (debridement), and the plastic surgeon immediately fills the void with healthy, vascularized tissue. Muscle flaps are particularly well suited for this, as they deliver high concentrations of antibiotics via the blood supply to the infection site.
Previous scalp injuries or skin grafts can result in unstable scarring. This scar tissue is often fragile, lacks sensation, and breaks down repeatedly with minor trauma, such as combing hair or wearing a hat. This cycle of ulceration and healing is painful and risky.
Reconstruction is indicated to replace this fragile scar with durable, full-thickness scalp tissue. This restores the patient’s ability to perform daily hygiene and wear headgear without fear of creating a new wound.
While often considered cosmetic, the correction of cicatricial (scarring) alopecia is a standard reconstructive procedure. Trauma, burns, or previous surgeries can leave large bald patches that are psychosocially debilitating.
Techniques such as scalp reduction (cutting out the bald area and pulling the hair-bearing edges together) or tissue expansion are used. The goal is to minimize the non-hair-bearing surface area and rearrange the remaining hair to provide maximum coverage.
In aggressive cancers like dermatofibrosarcoma protuberans (DFSP) or angiosarcoma, tumors often recur locally. This necessitates repeated, wider excisions that progressively deplete the available local scalp tissue.
Reconstruction in these cases is dynamic and challenging. The surgeon must plan for the possibility of future surgeries, preserving potential donor sites and vessels. It often involves a multidisciplinary tumor board to balance oncologic clearance with reconstructive feasibility.
An active, uncontrolled infection in the wound bed is a contraindication to definitive reconstruction. Placing a flap or graft over an infected bed will lead to failure, as the bacteria destroy the new tissue attachments.
The infection must be controlled first through debridement, antibiotics, and wound care. Only when the bacterial count is low, and the bed shows signs of healthy granulation, can the reconstruction proceed.
Send us all your questions or requests, and our expert team will assist you.
Yes, if the dent is caused by a missing piece of bone or contour irregularity, it can be corrected. This is often done using custom-made implants (PEEK or titanium) or bone cements, which are then covered by the scalp reconstruction.
If the scalp is too tight to close directly, we use other methods. We might make incisions in the galea to stretch it, use a local flap from nearby skin, or use a skin graft to bridge the gap. We never force it closed under high tension.
Yes, radiation makes scalp tissue stiff, impairs blood flow, and impairs healing. Surgery on an irradiated scalp carries a higher risk of wound breakdown. We often need to bring in healthy, non-irradiated tissue from elsewhere to ensure healing.
Yes, dog bites often cause avulsion (tearing) injuries. The priority is cleaning the wound to prevent infection. Depending on the size of the loss, we use local flaps or grafts to cover the area and restore the appearance.
Scalp surgery is generally well-tolerated, even in elderly patients, because it is superficial and does not involve internal organs. However, if the procedure involves prolonged anesthesia or free flaps, we carefully assess cardiac and pulmonary health first.
