Reconstruction of scalp defects is required for acute trauma, tumor extirpation, radiation necrosis, and the repair of traumatic alopecia or cosmetically displeasing scars. The proper choice of a reconstructive technique is affected by several factors—the size and location of the defect, the presence or absence of periosteum, the quality of surrounding scalp tissue, the presence or absence of hair, location of the hairline, and patient comorbidities.Cosmetic scalpreconstruction requires restoration and preservation of normal hair patterns and hair lines.The scalp vertex is an area of limited scalp mobility and requires extensive undermining and recruitment of tissue from the more mobile anterior, parietal, and occipital regions. The only 2 alternative for large defects (greater than 25 cm2 ) is large rotation-advancement flaps which require near complete scalp undermining.This article presents a case of Acute scalp Avulsion in the Vertex and the subsequent reconstruction using a large posteriorly based Rotation-Advancement Flap.
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