Background. Many patients with complex scalp and skull defects can benefit from scalp reconstruction using the trapezoid flap, reducing the morbidity of the donor site. The trapezius flap was first reported by Nakajima and Fujino in 1984. It was originally described as a myocutaneous or muscle flap, and it has also been used as a free flap. The blood that suppl y the trapezium muscle and the skin is mainly from the superficial and descending branches of the transverse cervical artery as well as the occipital artery. Case report. This work presents the clinical case of a 65 year old woman who was diagnosed with co rnified pluristrative squoamos cancer with bone destruction and invasion to confluence sinus and left transverse venous sinus, who underwent the occipital extra intracranial tumor removal. She addresses to our clinic with a massive defect of 10 by 18 cm. A fter making the operative planning, we decided to solve the case with distal trapezius muscle flap. Conclusions. The decision of the reconstructive technique should be taken into account with regarding to its consequences on the affected anatomical structures, the personal pathological antecedents and pre existing lesions at the level of the donor area.