This review represents the largest reported series involving reconstru
ction of complex scalp and calvarial defects with rectus abdominis fre
e flaps. Sixteen patients presented with extensive (up to 300 cm(2)) s
calp and calvarial defects requiring free tissue transfer for closure.
All of the 11 patients who underwent a rectus abdominis free flap had
a technically successful microvascular transfer. The defects encounte
red involved a wide spectrum of complexities including extensive multi
laminar defects with exposed brain and dura, irradiated fields, and in
fection. In our institutions, the rectus abdominis muscle has evolved
as a uniquely superior donor choice for restoring extensive scalp defe
cts for several reasons: (1) accessibility, which eliminates intraoper
ative patient repositioning and allows for a simultaneous two-team app
roach; (2) minimal donor-site morbidity; (3) vascular reliability; and
(4) the ability to supply abundant, easily contoured tissue.