The excision of tumors from the scalp is a frequent procedure in dermatologic surgery. The specifics of anatomy in this region, which is equipped with a musculoaponeurotic system that offers little elasticity, prevent repairing a defect by direct closure when it is greater than 2cm in diameter. The scalp is also highly vascularized and the abundance of anastomoses available favors the survival of flaps even if their pedicles are narrower than is usual. Medium-sized scalp defects are therefore often reconstructed with flaps, the most commonly used ones being the classic rotation flap or the O-Z double rotation flap. These reconstructions achieve their objective, but at the expense of detaching and mobilizing fairly large areas of tissue.

In this issue of Actas Dermo-Sifiliográficas, Francisco Russo1 analyzes his experience repairing scalp defects in a series of over 100 patients using a mnemonic “1–2–3” rule for starting the reconstruction of medium-sized defects of 1 to 4cm. The rule refers to starting the process with 1, 2 or 3 release incisions depending on whether the defect measures 1 to 2cm, 2 to 3cm, or 3 to 4cm. About half the cases in the series were repaired using these release incisions. When closure cannot be achieved with this initial approach, the author proposes extending the incisions to create classic flaps.

The author has previously given other original suggestions to help us make improvements in our customary surgical procedures.2 This issue's article offers a practical, simple, and stepped approach to reconstructing defects after scalp surgery.1