Anterolateral Thigh Flap for Reconstruction of Massive Scalp Defect Following Surgery for a Malignant Tumor

Large soft tissue defects in the scalp following wide excision of bulky malignant tumors can pose challenges for reconstruction, particularly when the skull or dura mater is exposed or cerebrospinal fluid is leaking. The authors reviewed our experience with using an anterolateral thigh (ALT) flap to repair large scalp defects in 11 patients between 2020 and 2025. Patient demographics, indications for reconstruction, flap selection, complications, and outcomes were documented. In 9 patients, the donor vessels were anastomosed to the superficial temporal artery and vein. All flaps survived. A single-pedicle double-island Kiss flap was used in 2 patients. Among the 2 patients in whom the donor vessels were anastomosed to the cervical vessels, one patient experienced a vascular crisis leading to flap necrosis, while the other patient’s flap survived. The flap necrosis was successfully repaired using a contralateral ALT femoral flap. The donor site was repaired with skin grafting in 3 patients and with the wounds closed linearly in the remaining 8 patients. In conclusion, the ALT femoral flap achieves high flap survival rates and excellent cosmetic outcomes and is thus suitable for the reconstruction of large scalp defects. Different flap configurations can be selected based on specific conditions. In addition, the fascia lata can be used to repair dural defects. The superficial temporal artery and vein are the preferred recipient vessels.