Scalp and Forehead Defects in the Post-Mohs Surgery Patient

Scalp and forehead reconstruction after Mohs micrographic surgery can encompass subcentimeter defects to entire scalp reconstruction. Knowledge of anatomy, flap design, and execution will prepare surgeons who operate in the head and neck area to confidently approach a variety of reconstructive challenges in this area.

Key points

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The loss of hair-bearing skin poses unique challenges in reconstruction.
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The scalp is less elastic than other areas of the head and neck, making reconstruction challenging.
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Forehead and scalp reconstruction after Mohs micrographic surgery is commonly encountered by head and neck reconstructive surgeons.
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Defects can be less than a centimeter or encompass most of the scalp, requiring a multitude of reconstructive techniques.
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Goals of forehead and scalp reconstruction are to maintain form and function while keeping patient facial aesthetics intact.
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For small to moderate lesions, local flaps are the mainstays of therapy, and for larger defects, microvascular free tissue transfer is becoming the backbone of therapy, especially for complex wounds.