Case II. The patient, female, 52 years old, was admitted into the hospital because of recurrence of the parietooccipital scalp leiomyosarcoma at the third month after surgery. The preoperative examination showed that there was a skin graft area slightly on the right side of the parietooccipital area. There were several nodular masses with local skin ulceration in the center of transplanted skin graft, and the whole skin graft was closely adhered to the deep periosteum without mobility. Preoperative examination found no tumor metastasis. The recurrent scalp tumor was extensively resected under general anesthesia, and the full-thickness scalp and periosteum were removed by extending 2 cm along the margin of the original skin transplantation area. During the removal process, the intraoperative frozen section examination was carried out by layers for various layers of removed tissues to guide the scope and layers of the removal. The results showed that the tumor tissue had invaded the meninges, and the removal of all tumor tissues led to defects in scalp and skull and dura mater. The exposed wound of brain tissue was 12 cm × 12 cm. We harvested the latissimus dorsi muscular flap and part of serratus anterior muscle fascia for free transfer to cover the brain tissue, harvested the femoral fascia lata to repair the dura mater defect, used the Medpor biological materials to repair the skull defects, carried out the microvascular transplantation of free latissimus dorsi muscle flap to cover the Medpor, and finally carried out the free transplantation of split-thickness skin graft to repair the scalp wound on the transplanted latissimus dorsi muscle. The body of the patient recovered well after surgery, and the wound healed at the first stage. The removed tissues were definitely diagnosed as leiomyosarcoma of the scalp by the paraffin pathological section examination, and the patient insisted on taking traditional Chinese medicine after surgery. After a four and a half years follow-up, the ulceration appeared at the original surgical site, and a mass was found at the right retroauricular area, which was resected and then was diagnosed as recurrence of scalp melanoma and lymph node metastasis by pathological examination. The patient and her family insisted on reoperation. It was intraoperatively found that the tumor tissue had invaded the original repair tissue, local brain tissue, and sagittal sinus, and all lesion tissues could not be removed completely. Therefore, the burning electric coagulation was performed for the involved tissues at the superficial surface of the brain tissue and sagittal sinus, and the original repair tissue was removed, and then the transplantation of free latissimus dorsi myocutaneous flap was performed under microscopy to repair the scalp defect. The myocutaneous flap survived after surgery, but the inflammatory tissue oozed out under the flap continuously after surgery, and a prolonged unhealed chronic inflammatory sinus tract was formed; thus, only long-term dressing change could be performed to keep the wound clean and maintain smooth drainage under the flap (Fig. 12.2). The patient died of systemic tumor metastasis and multiple organ failure 1 year after surgery.