Summation of Approaches and Principles in Occipital Scalp Reconstruction: A Case Report and Literature Review.

Background: Complex scalp defects present unique reconstructive challenges owing to limited tissue availability, reduced pliability, and positional difficulties. Although scalp reconstruction techniques are well documented, literature specifically addressing occipital defects is limited. This study reviewed the reconstructive strategies for occipital scalp defects and presented a case report. Methods: A scoping literature review was conducted using PubMed and Ovid to identify studies on occipital scalp reconstructions. Additionally, we present a case of a 78-year-old man with recurrent squamous cell carcinoma of the left occipital scalp. After wide local excision with clear margins, the patient underwent a staged reconstructive approach involving wound size reduction with adjacent tissue transfer and negative pressure wound therapy (NPWT), followed by a local rotation flap with V-Y advancement. Results: Initial defect management involved burring the exposed occipital bone to promote vascularization, partial closure with adjacent tissue advancement, and NPWT application. Eleven weeks later, a proximally based pentagonal rotational flap was performed with V-Y advancement for donor-site closure. The patient remained well healed at 17 months of follow-up without complications. Our literature review identified 23 publications describing various techniques for reconstructing occipital defects. No review articles focusing on occipital scalp defects were identified. Conclusions: Occipital scalp reconstruction requires tailored strategies that consider anatomical, wound-, and patient-specific factors. This case highlighted a successful staged approach for optimizing adjacent tissue transfer while minimizing surgical morbidities. Given the limited literature on occipital-specific scalp reconstruction, further studies are required to establish the best practices for managing occipital scalp defects.