Galeal/periosteal flaps for the reconstruction of large scalp defects with exposed outer table

Abstract

Conflicts of interest: none declared. Large surgical defects of the scalp provide a challenge for the reconstructive surgeon due to the relative inelasticity of scalp skin and the lack of an adjacent tissue reservoir. Often they necessitate a repair utilizing a full‐ or partial‐thickness skin graft. Not uncommonly, however, Mohs extirpation of more extensive or aggressive tumours may necessitate removal of periosteum resulting in exposure of bare bone, which is an avascular bed and may not support a skin graft placed directly upon it.1 The role of cortical bone fenestration in facilitating granulation of such defects to heal by secondary intention has recently been elegantly described by Barry et al.2 We discuss our techniques of utilizing galeal/periosteal flaps (GPFs) to resurface exposed bone, providing a vascular bed for a skin graft and allowing immediate reconstruction of large scalp defects. The procedure is performed under local anaesthetic as a day‐case. Following tumour extirpation, the wound and surrounding scalp are prepared and draped in a standard fashion. A radial incision is made through skin and subcutis only, at least 1·5 times the width of the surgical defect, to permit access to the underlying galea and facilitate dissection of the GPF (Fig. 1a). For smaller defects with exposed bone a single access incision may suffice. More commonly, however, an access incision either side of the defect is required to elevate two tension‐free GPFs and provide adequate bone coverage (Fig. 1b).