Nearly the entire scalp and forehead may be divided and raised into different hair-bearing, cutaneous or composite flaps. These flaps are based on the superficial temporal vessels, the supratrochlear vessels and/or the occipital vessels.
Hair-bearing flaps are used for reconstruction of moderate-sized defects in the frontal or occipital region. The Orticochea triple scalp flap consists of two flaps based on the superficial temporal vessels on each side and a larger third flap based on both occipital arteries.17 The flaps are elevated in the loose areolar tissue plane between the pericranium and the galea aponeurotica. Many parallel incisions are made in the aponeurosis of the flaps to increase mobilization. The flaps are then advanced and sutured to each other over the defect (Figure 18-11).
Flaps based on the parietal branch of the superficial temporal artery include only hair-bearing skin (the tem-poroparietooccipital flap). This flap may be used for reconstruction of the anterior hairline, eyebrow, and mustache. Flaps based on the frontal branch of the superficial temporal artery may include hair-bearing skin and the forehead (scalping flap), or the entire forehead unit (frontal flap). If based on both superficial temporal arteries, a visor flap may be raised. Scalping and frontal flaps have been used for reconstruction of the nose, midface and the intraoral lining (Figure 18-12). An important disadvantage of the scalping of frontal flap is that the donor site has to be skin grafted.18
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