Scalp and Calvarial Reconstruction — Local Flaps, Free Tissue Transfer, and Cranioplasty

This episode reviews the core principles of scalp and calvarial reconstruction, focusing on scalp anatomy, vascular supply, soft tissue coverage, and skull reconstruction.Topics include the five layers of the SCALP, the importance of the loose areolar “magic plane,” the danger space, the galea, and the role of the pericranium as a vascular bed for skin grafting. The episode also reviews the major scalp blood supply, including the supratrochlear, supraorbital, superficial temporal, posterior auricular, and occipital arteries.Reconstructive strategies are reviewed using the reconstructive ladder, including primary closure, galeal scoring, split-thickness skin grafting, burr-down to diploë, local rotation flaps, pinwheel flaps, Orticochea flaps, tissue expansion, and free flap reconstruction. Special attention is given to reconstruction in radiated or infected fields, where local tissue and expanders may fail.Calvarial reconstruction is discussed through both autologous and alloplastic options, including split calvarial grafts, rib grafts, methyl methacrylate, titanium mesh, and custom PEEK implants. Additional topics include the crane principle, recipient vessel selection, scalp replantation, sagittal sinus safety, rib harvest complications, and principles of cranioplasty material selection.Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons. DisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic Keywordsscalp reconstruction, calvarial reconstruction, cranioplasty, SCALP layers, galea scoring, loose areolar tissue, pericranium skin graft, burr down to diploë, pinwheel flap scalp, Orticochea flap, tissue expansion scalp, latissimus free flap scalp, ALT flap scalp reconstruction, omental flap infection, split calvarial graft, rib graft cranioplasty, methyl methacrylate cranioplasty, titanium mesh, PEEK implant, crane principle, scalp avulsion replantation