Extreme Surgery: Scalp Reconstruction

Warning: this is a medically graphic reconstructive plastic surgery procedure that I recently performed. This content may not be suitable for all readers.

This complicated scalp reconstruction was due to a very large cancerous lesion on this man’s scalp. After undergoing Moh’s surgery, where the cancer is removed with a margin by a dermatologic surgeon, I reconstructed his scalp.Unfortunately, as the sole plastic surgeon with Schweiger Dermatology Group, I do a fair amount of skin cancer based reconstruction. The scalp is an area where people often forget, or find it too difficult, to apply sun screen. And, it is an area where growing cancerous lesions can go undetected for too long due to the growth of hair around it.

This reconstruction was complex, because with a defect this large, the wound cannot be closed directly. In terms of plastic surgery difficulty, I would say this is a 9.0 out of 10. Prior to surgery, this patient was a 47 year old gentleman with a full head of hair. For the procedure, I created “pinwheel” flaps of tissue from the surrounding scalp to close his wound. The flaps come together like the aperture of a camera to complete the reconstruction. Skin and tissue have a fair amount of elasticity, which allowed me to close the three incisions in the pattern you see in the image to the left. I planned these incisions carefully to align with the patient’s hair growth pattern, and when his hair regrows, the scar will be essentially invisible – like nothing ever happened! This is the miracle of surgery! Plastic surgery is an amazing field, and this is a great reconstructive result that I am quite proud of.