Latissimus Dorsi Free Flap: Subfascial Flap Dissection in a Case of Scalp and Forehead Reconstruction.

Total avulsion of the scalp represents a therapeutic challenge with no consensus nowadays. Currently, microsurgical reimplantation is the reconstructive procedure of choice, but in case it is not feasible, the literature does not define an ideal treatment for an immediate reconstruction. We present the case of an 18-year-old woman with total avulsion of the scalp and forehead skin without possibility of reimplantation. We performed the surgical reconstruction with a latissimus dorsi free flap, and to achieve greater malleability, the flap was harvested without fascia. A large coverage was immediately achieved, and 1 year after the procedure, the patient showed excellent cranial symmetry and a high level of satisfaction. The optimal treatment of total avulsion of the scalp with no option of reimplantation remains a challenge. In our case, the subfascial dissection increased the flap area to cover the defect. Our procedure could be considered as an alternative surgical strategy in flap harvest, but more cases are needed.