Plastic surgery for scalp defects reconstruction:
Scalp reconstruction for complex Scalp defects following scalp cancer removal , traumatic skin loss, scalp electrical burns or scalp infections can present many challenges.
Reconstruction of the scalp follows the reconstructive ladder : healing by secondary intention; primary closure; advancement flap; rotational flap; use of split-thickness skin graft or full-thickness skin graft ; and free flaps.
The selection of methods depends on anatomical factors such as skin laxity, wound depth, location & patient conditions.
Traumatic scalp avulsive injuries can be devastating.
Also high voltage electrical burns Injuries frequency cause loss of huge scalp tissues till underlying skull bone.

Primary closure
The ideal wound to do primary closure is any full thickness wound where the edges can be opposed with minimal tension.
Advancement Flap
The ideal location for this option is on the scalp is where there is redundant local tissues.
Rotational Flap
The ideal wound for a rotational flap is any full thickness wound where the edges are not closable with primary closure & there is redundant local tissue and where the incision lines are hidable within cosmetic subunits.
Transpositional flap
Similar to indications with advancement and rotational flaps, but the flap moves laterally over normal intervening skin for placement into the defect. Donor area is partly grafted.
Split-thickness skin grafts (STSG)
The ideal wound for an STSG is any full-thickness scalp wound where there is no exposed skull bone in the wound bed.

In cases of total scalp avulsion injuries & very huge scalp defects microsurgery and free tissue transfer techniques are used.
The flaps require preservation of the natural hairline, incorporation of major vascular pedicles, and closure without tension.