Scalp Reconstruction After Mohs Surgery

Question

My scalp has no laxity, and I have had previous scalp surgeries to treat injuries. Now, I have been diagnosed with basal cell carcinoma, which will be excised soon. The wound cannot be closed; it must heal by second intention (time and wound care). I will be left with a fairly large bald spot that my hair cannot cover. I do not want a hair transplant. What are my reconstructive surgical options? Tissue expansion? Could tissue expansion cause tissue necrosis?

Ross Kopelman, DO · Answer

Given your lack of scalp laxity and previous surgeries, tissue expansion is one option for covering the bald spot after Mohs surgery. It involves stretching the skin over time to cover the wound, but it does carry some risk of tissue necrosis, especially in areas with scarring or reduced blood flow.
Other possibilities include local flaps, though limited laxity might make that tricky, or skin grafts from another part of your body, though they won’t look or feel the same as scalp skin.

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