ABSTRACT
<p><b>INTRODUCTION</b>Scalp soft tissue defects are common and result from a variety of causes. Reconstructive methods should maximise cosmetic outcomes by maintaining hair-bearing tissue and aesthetic hairlines. This article outlines an algorithm based on a diverse clinical case series to optimise scalp soft tissue coverage.</p><p><b>MATERIALS AND METHODS</b>A retrospective analysis of scalp soft tissue reconstruction cases performed at the Singapore General Hospital between January 2004 and December 2013 was conducted.</p><p><b>RESULTS</b>Forty-one patients were included in this study. The majority of defects <100 cm² were reconstructed with local flaps and were subdivided by location. Methods included rotation, transposition and free flaps. The most common type of reconstruction performed for defects ≥100 cm² was free flap reconstruction. Multistage reconstruction using tissue expanders aided in optimising cosmetic outcomes. There were no major complications or flap failures.</p><p><b>CONCLUSION</b>By analysing our experience with scalp soft tissue reconstruction, we have developed an algorithm based on defect size and location, achieving excellent closure and aesthetic outcome while minimising complications and repeat procedures.</p>