Abstract
INTRODUCTION AND IMPORTANCE: Scalp tumors are diverse, with the characteristics of individual tumors depending on the cell lineage. Invasive squamous cell carcinoma and sarcomas of the scalp are a variety of uncommon, aggressive neoplasms of the head and neck. Resecting large invasive tumors causes extensive full-thickness scalp defects, and repairing these defects remains challenging. CASE PRESENTATION: The authors present two successful cases using a staged approach with titanium mesh and free tissue transfer (anterolateral thigh flap) technique. CLINICAL DISCUSSION: Complex scalp defects are challenging to manage when insufficient local tissue is available. This frequently necessitates the use of microvascular free tissue transfer for reconstruction. The availability of microsurgery in developing countries such as ours has enabled functional and aesthetic reconstruction for patients presenting with such complex defects. CONCLUSION: Free flaps are safe and reliable when scalp defects are significant and require both scalp and calvarial reconstructions. The ALT-free tissue transfer shows predictable results in both clinical cases.