Scalp Reconstruction of an Extensive Full-thickness Postresection Defect of a Recurrent Scalp Sarcoma in a 3-year-old Boy

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We present a case of huge recurrent spindle cell sarcoma in a 3-year-old boy's right temporoparietal scalp, which was initially misdiagnosed as a hemangioma and was primarily excised after an unsuccessful trial of oral propranolol. The tumor recurred and responded to adjuvant chemotherapy. After wide local excision with a frozen section confirming clear margins, a combination of free latissimus dorsi myocutaneous flap, scalp rotational flap, and split-thickness skin graft was used to resurface the extensive postresection defect. However, the patient experienced marginal flap necrosis postoperatively and required multiple operations to achieve adequate soft tissue coverage. His hospitalization was also prolonged because of surgical site infection over the scalp and skin graft donor sites, which required intravenous antibiotics and regular dressing changes. The patient has been disease free after discharge with no remarkable functional deficit. In our opinion, the best tool for reconstruction of extensive scalp defects is free flaps.