Reconstruction of refractory defect of scalp and skull using microsurgical free flap transfer.

Ten patients--six with acute burns, two with old accident or surgical trauma, and two with cranial carcinoma--experienced extensive full-thickness necrosis of the scalp and necrosis or defect of underlying skull bone. Microsurgical free flaps were used for the repair. Four latissimus dorsi, two rectus abdominis, one greater omentum, one prefabricated omentum-cutaneous flap, and two vascularized outer-table of the cranial bone flaps were used with complete survival. The heat-devitalized cranial bone covered by living tissue flaps healed well and substantial "regeneration" of previously necrosed bone was shown by roentgenogram, bone scan, and histopathological examination in the postoperative follow-up. Choosing an artery with high perfusion, bypassing from the carotid artery to support a massive free flap, is recommended.