Snail Flap for Scalp Reconstruction: Technique and Outcomes.

Objectives: Local flaps are widely described for scalp reconstruction, but there is minimal literature surrounding the snail flap. The objective of this study was to describe the surgical technique and outcomes of scalp reconstruction with the snail flap.

Methods: This case series retrospectively evaluated all consecutive patients undergoing scalp snail flap reconstruction from January 1, 2019 to February 1, 2024. The primary outcome measure was incidence and extent of complications. Demographic and intra-operative variables were assessed.

Results: A total of 44 patients were included with a median age (range) of 74 years (27-88) with scalp defects ranging in size from 3 x 3 cm to 8 x 8 cm (median defect size 5 cm). The mean (SD) flap base-to-defect ratio was 1.82 (0.31). Forty (91%) of the cases were performed outpatient or with overnight observation only. Complications included 9 (20%) wound infections, 12 (27%) patients with necrosis (all minimal), and 2 (5%) patients with hematoma, which were all managed outpatient. The flap survival rate was 100%.

Conclusions: The snail flap is easy to perform with high reliability and allows for hair preservation. The morbidity and need for hospitalization are minimal, making it an ideal reconstructive option for elderly or frail patients with moderate-sized scalp defects.