Management of Scalp Substance Loss: Surgical Techniques and Clinical Outcomes Based on an Anatomoclinical Framework

Abstract: Background: Scalp substance loss (SSL) poses a complex surgical challenge due to the anatomical rigidity and aesthetic importance of the region. Rich vascularization and anatomical peculiarities allow diverse reconstructive options, ranging from primary closure to complex vascularized and free flaps. Methods: This retrospective study evaluates surgical techniques for SSL reconstruction over 36 months in a single center. Patients were stratified based on defect size, depth, location, and etiology. Outcomes, complications, and patient satisfaction were analyzed. Results: A total of 48 patients (mean age 42.7 years) were treated. Lesions ranged from 2 to 20 cm. Reconstruction techniques included direct sutures (22.9%), skin grafts (18.7%), local flaps (35.4%), tissue expansion (14.6%), and free flaps (8.3%). Flap survival was 95.8%. Minor complications occurred in 27.1% (mainly flap edge necrosis and delayed healing). Aesthetic satisfaction was high in 89.5% of cases. Conclusion: The choice of technique depends on an individualized anatomical and etiological analysis. Vascularized flaps and tissue expansion offer reliable and aesthetically pleasing results for moderate to large SSL.