Repair of scalp defects using an H-plasty type of bilateral advancement flap

Background Defects of the scalp often pose a reconstructive challenge in dermatologic surgery. Objective We report our experience with the H-plasty type of bilateral advancement flap for the closure of small to medium-sized scalp defects that cannot be closed primarily. Methods In this case series study, 69 scalp defects 1.5 to 3.0 cm in diameter that could not be closed primarily were repaired using the H-plasty type of bilateral advancement flap. Results Sixty-nine 1.5- to 3.0-cm-diameter scalp defects resulting from Mohs micrographic surgery that could not be closed primarily were identified over the 2-year study period. All 69 defects were closed entirely with the bilateral advancement flap, and there were no significant complications. Conclusions The H-plasty type of bilateral advancement flap allows appropriately selected scalp defects that might not be readily closed primarily to be repaired easily using local skin, providing an attractive alternative to other flap techniques, skin grafting, and healing via secondary intention. The limitations of this study are that the results are based on a retrospective single-surgeon experience and that there was no long-term follow-up scheduled to evaluate the final cosmetic outcome of the repair.