We report our experience with 42 coverage flaps for tissue loss involving the scalp. Malignant tumors of the scalp were the major cause of tissue loss. Repair modalites and outcome are reported. This series included 23 local flaps, one pediculated regional flap, and 18 free flaps associated with three cranioplasties and four dura mater plasties due to invasion of the subjacent tissues. We discuss therapeutic indications and insist on selection criteria which depend on etiology (localization, form depth), local factors (integrity of the pericranium and subjacent structures) and general factors (age, sex, physical and psychological status, socioprofessional context, patient expectations). In all cases, we opted for tissue repair which offers greater safety with minimum function and esthetic morbidity.
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