Gallardo Santiago Regina, Villarreal Salgado José Luis, Méndez Chávez Jorge Eduardo, Guzmán Pérez Fernanda Pamela
Introduction: Cutaneous squamous cell carcinoma of the scalp requires complete oncologic excision followed by reconstruction that provides durable soft-tissue coverage while preserving scalp contour and hair-bearing tissue. Local rotation flaps remain a reliable reconstructive option for appropriately selected defects. Case Presentation: A 94-year-old man presented with a progressively enlarging left frontotemporal scalp lesion. Wide local excision with oncologically appropriate margins was performed, followed by immediate reconstruction using a wide-based local rotation flap elevated in the subgaleal plane. The flap achieved tension-free closure with preservation of scalp contour. Histopathological examination confirmed invasive cutaneous squamous cell carcinoma with negative surgical margins. The postoperative course was uneventful, with complete primary wound healing and no evidence of regional or distant metastasis. Discussion: Local rotation flaps remain a safe and effective reconstructive option for selected scalp defects following cSCC excision, providing reliable vascularity, tension-free closure, and favorable functional and aesthetic outcomes, even in elderly patients. Conclusion: This case highlights the role of local rotation flaps as a dependable first-line reconstructive option for selected scalp defects following cSCC excision, achieving durable coverage with favorable functional and aesthetic outcomes.