Restoring the Crown: Modern Strategies in Scalp Reconstruction

Scalp surgery encompasses a range of procedures performed for functional and cosmetic purposes, most commonly involving the excision of malignant tumors and the subsequent reconstruction of acquired defects. The unique anatomic challenges of the scalp, including its dense vascularity, limited tissue mobility, and proximity to the calvarium, necessitate a meticulous and tailored approach. The choice of reconstructive technique is dictated by defect characteristics, with options spanning primary closure, local flaps, skin grafts, dermal regeneration templates, and free tissue transfer for the most complex cases. Multidisciplinary collaboration is often critical, particularly for defects with cranial involvement requiring concurrent cranioplasty. Key considerations for success include the preservation of neurovascular structures, maintenance of natural hair orientation, and careful preoperative planning to minimize complications. This review outlines the fundamental principles and algorithmic approach to scalp surgery, emphasizing the importance of selecting the appropriate reconstructive strategy to achieve optimal oncologic, functional, and aesthetic outcomes.