Sequential multi-reconstructive approach to a massive scalp defect: a case report.

Reconstruction of scalp defects continues to be a surgical challenge due to its anatomical and functional characteristics. The ideal reconstructive technique between local flaps, tissue expanders, dermal matrices, the use of negative pressure system and free flaps should provide durable and aesthetically acceptable coverage based on the etiology, defect size, local tissue availability, and patient comorbidities; with the aim of preserving hairlines, coverage with hair-bearing skin and preventing antiesthetic scars and areas of alopecia. We present a case of scalp avulsion affecting 90% of the total area, in which multiple surgical strategies were used to achieve the stated objective.