Soft tissue coverage of cranial defects: an update

Scalp and cranial defects can occur as a result of cutaneous or bony malignancies, trauma, or surgical intervention for intracranial tumors. Soft tissue cranial reconstruction of composite defects presents a unique challenge given the relative tissue inelasticity of the scalp, need for tension free closure, and convex shape of the cranium. An added complexity is found in patients with large defects, cerebrospinal fluid leak, prior failed reconstruction, infection, or previous radiation. Methods and materials for skull reconstruction have evolved significantly over the years, allowing surgeons to repair even the most challenging composite defects with excellent success rates. This review aims to discuss and evaluate the available soft tissue options for cranioplasty coverage, with particular focus on hostile reconstructive fields and the use of free tissue transfer.