[42] In other words, the ALT flap can be harvested as thinned skin, or a fasciocutaneous flap, myocutaneous flap, or chimeric flap to provide the necessary volume to restore a natural scalp contour. In 2004, Heller et al.[17] Ibrutinib in vitro reported the use of ALT fasciocutaneous flaps to provide different tissue components for the repair of dura and scalp. The well-vascularized fascia components of ALT flaps were used to successfully to seal dural defects and overcome refractory infection in the area. This concept was applied successfully in three of our cases following extirpation of tumor involving

the scalp, bone and dura. Successful dural seal provided by the fascia component in these cases prevented cerebrospinal fluid leakage. With regards to donor-site morbidity, Boca et al.[20] concluded in his study that primary closure can be expected Protein Tyrosine Kinase inhibitor when the maximum

width of the ALT flap was less than 16% of the thigh circumference, beyond which split-thickness skin grafts should be used to assist in closure. Donor site analysis showed that primary closure was preferred over skin graft wherever possible, as the latter would limit the range of motion at the hip and knee joint owing to adhesions between the skin graft and underlying muscle.[43] Cranioplasty is performed for both functional and aesthetic restoration of the cranial vault, the former being protection of intracranial contents and the latter for restoration of the natural head contour.[44] However, the decision for cranioplasty can only be made after stabilization of the patient

and the intracranial pathology.[45] Our experience with five patients in this series demonstrates this basic principle, where patients underwent cranioplasty for intracranial protection and restoration of calvarial contour after resolution of head injury. These patients underwent local flap coverage as the first line of treatment, as this represents Cell press the best option for reconstruction of scalp defects. The ALT flap was used only when this option failed to achieve its goal. Our patients invariably express dissatisfaction to being socially handicapped, due to the unsightly appearances of exposed hardware or prosthesis after wound dehiscence or breakdown of the local scalp flap. Compared to local flaps, the free ALT flap proved competent in expedient coverage of these defects, had shorter recovery time and minimized damage to remnant scalp. Superficial temporal vessels are most commonly used as recipient vessels in free flap reconstruction of a scalp defect, not only because of their superficial location, but also its proximity to scalp defects. Scalp defects commonly occur in the anterior scalp, and in particular the frontal and temporal regions.[18] In our series, the superficial temporal vessels were used in seven out of nine patients.