Extensive scalp reconstruction after repeated failure of free tissue transfer with a pedicled latissimus dorsi flap.

Extensive scalp defects after surgical ablation often require free tissue transfer. However, if free tissue transfer cannot be used, pedicled flaps derived from distant tissue could provide an alternative method of achieving scalp coverage. The latissimus dorsi (LD) flap is commonly used as free flap; however, it can also cover a defect from the occiput to the vertex as pedicled flap with complete division of humeral insertion and exposure of pedicle. Here, we report a case of extensive scalp defect covered with a pedicled LD flap after repeated failure of free flaps. Flap survived completely after complete division of the pedicle on postoperative day 25, although the defect bed contained alloplastic material.