Scalp reconstruction is a surgical procedure for people with scalp defects. Scalp defects may be partial or full thickness and can be congenital or acquired. Because not all layers of the scalp are elastic and the scalp has a convex shape, the use of primary closure is limited. Sometimes the easiest way of closing the wound may not be the ideal or best way. The choice for a reconstruction depends on multiple factors, such as the defect itself, the patient characteristics and surgeon preference. Skull and brain 'surgery' are known from the prehistoric era. There is evidence of scalp reconstructions dating back to the Egyptians in 3000 B.C., and to the Roman Empire.
Attempts were made to reconstruct damaged skulls despite minimal knowledge of neurology, anatomy, and the brain. Skulls showing manipulation that can be interpreted as a primitive form of surgery have been found from various eras around the world. In Medieval times, people were convinced that trepanation was a remedy for various diseases. Main reasons for scalp reconstruction are divided into two groups: congenital or acquired. Congenital defects may include aplasia cutis congenital, congenital nevus, congenital vascular malformations and congenital tumors. Acquired defects can be caused by burns, blunt, penetrating, or avulsion injuries, tumor invasion, infection, oncologic resection, radiation, or wound-healing difficulties. Alopecia can be an aesthetic motivation for hair-bearing scalp reconstruction. As the incidence of basal-cell carcinoma and squamous-cell carcinoma is rising and about 80% are located in the head and neck area, the number of scalp reconstructions will likely increase in the future. Depending on the size and nature of the defect, an appropriate reconstructive method has to be used. By using Mohs surgery the defect can be kept minimal, but nevertheless infiltrative basal cell carcinoma may have the need to remove a large part of the scalp.