In severe, infected scalp defects, locally available tissues are not sufficient for reconstruction and are often unhealthy. In this situation, healthy free tissue transfer offers abundant vascularity of uncompromised tissue that can control infections and a single-stage reconstruction. Between March 2002 and May 2010, 18 patients (20 cases) underwent traumatic scalp defect reconstruction with coincident infections as follows: 16 cases of postcranioplasty infections with previous traumatic open skull fractures and 4 cases of traumatic defects with infections without cranioplasties. Eighteen patients underwent 20 latissimus dorsi free flaps: 8 cases were latissimus dorsi perforator flaps without muscle and 12 cases were latissimus dorsi myocutaneous flaps. The mean flap size was 214 cm. All patients healed well during the follow-up period. A latissimus dorsi flap in the supine position is an alternative for reconstruction of scalp defects with postcranioplasty or traumatic infections.
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