New technique for bloodless surgery to the scalp

Abstract

Skin cancers such as malignant melanoma, squamous cell carcinoma, and basal cell carcinoma are common on the scalp, and the usual treatment is wide local excision with disease- free margins. Margins vary depending on the type of cancer, the size and depth of invasion, and the cytological findings, as described in the British Association of Dermatology guidelines. Because the blood supply of the scalp is rich, excision is usually accompanied by brisk bleeding, which can be troublesome and even affect the success of the graft. The layer of connective tissue between the skin and the epicranial aponeurosis consists of lobules of fat bound in tough fibrous septa, through which the main blood vessels that supply the scalp travel. Because these vessels are attached to this fibrous layer, they do not easily go into vasospasm when cut, which results in profuse bleeding. When lacerated they may also retract between the septa, which causes more pronounced bleeding and it may take a considerable time to achieve haemostasis. Diathermy may injure hair follicles in the remaining skin and induce additional alopecia. Here we present a new technique that considerably reduces bleeding and consequently saves time and reduces the need to use diathermy.