Emergency Scalp Reconstruction Using Transposition Flaps: A Case Series of 12 Patients

Abstract: Introduction: Extensive scalp defects, particularly those with bony exposure, represent a surgical emergency requiring rapid and reliable coverage. The parieto-temporal transposition flap is a simple, safe and effective technique for this type of reconstruction. Patients and methods: We report a series of 12 patients undergoing emergency surgery between January 2021 and January 2023. The main indications were post-traumatic defects (7 cases), post-infectious necrosis of the surgical site (4 cases) and deep burns (1 case). All patients received a parieto-temporal transposition flap. A skin graft of varying thickness was used to cover the donor site in 11 cases, and directed wound healing was used in 1 case. Results: The mean age was 51 years (8 women, 4 men). The average time to management was 2.5 days for trauma-related defects and 15 days for post-infectious defects after appropriate debridement and antibiotic therapy. Two patients developed suture dehiscence requiring revision surgery, and one patient developed venous congestion of the flap, which resolved with appropriate dressings. No complete flap loss or secondary infection was observed. Average follow-up was 12 months, with favorable results. Conclusion: The parieto-temporal transposition flap is a simple, rapid and reliable option for emergency coverage of scalp defects with bone exposure. It reduces infectious complications and achieves good aesthetic results.