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A rapid, simple, and inexpensive computed tomographic technique has been developed for marking the scalp and lateral skull radiograph of patients with small cerebral convexity lesions. The more precise localization provided thereby facilitates planning and performance of surgery.
Three cases of hemorrhagic nerve sheath tumors of the scalp are presented with emphasis on CT findings. Each mass produced a mixed pattern of CT density due to the combination of tumor and hemorrhage within it. The CT findings were remarkably similar in the three patients and included a calvarial abnormality underlying the mass in each.
Scalp avulsions of various origin are frequently seen, owing to rapid industrialization and the increased incidence of road-traffic accidents. This article deals with 20 such cases seen and treated by the authors in the last 5 years. The victims were predominantly young females. The anatomic and pathophysiologic aspects of avulsion injury are considered in detail, and various modalities of treatment are discussed. With intact pericranium, split-skin grafting remains the treatment of choice. In the presence of bare bone, local flap is preferred, if feasible. If not, then the outer table of the skull is chiseled out or multiple drilling is done through it to accelerate the formation of granulation tissue. Subsequently, this is covered by split-skin grafting. Of course, the grafts do not grow hair and the patients need to wear a wig for total psychological and functional rehabilitation. Prevention remains still the best remedy.
Stimulation of the motor cortex transcranially has shown a rough somatotopy of stimulation sites on the scalp corresponding to the homunculus and preferential activation of contralateral hand muscles, as well as very short latencies of signals in the cervical spinal cord. The responses are also facilitated by background activation of the muscles. We are reporting a set of patients studied using electrical and magnetic stimulation transcranially. We observed that the latency of electromyogram activation is much shorter in active than contracting muscles and that the muscle twitch produced by cortical stimulation can exceed the force produced by supramaximal stimulation of the peripheral nerve. Our findings suggest that this may be due to multiple firing of motor neurons. Another observation is that magnetic stimulation is not as subject to a reduction in the response latency with facilitation, and response latencies with magnetic stimulation were 2 ms longer than with electrical stimulation. The implications of these findings are discussed.
A deltovertebral flap based on the perforating cutaneous branches of the posterior intercostal vessels (the exact opposite of the deltopectoral flap) was used successfully to cover a large scalp defect. The procedure is a rather hazardous one, due to the numerous stages and the awkward postoperative position. However, it may be used to repair the lateral aspect of the neck or the occipital region when a flap is necessary and other methods are not feasible.
A technique for reconstruction of the anterior hairline, with undelayed lateral scalp flaps, is presented. Unilateral and bilateral flaps have given excellent results in selected patients with a variety of balding patterns. The advantage of gaining instant hair of good density along the anterior hairline is one not provided by the free graft techniques. The continued high patient acceptance and the minimal morbidity encourage further clinical study of this method with cautious enthusiasm.
We have used 25 rotation scalp flaps to treat occipital baldness associated with fronto-parietal baldness (the third flap), and 35 such flaps for the correction of isolated occipital baldness. We have not had any flap necrosis, and our patients have been well satisfied with the results of this surgery.
A case report of a congenital scalp defect, associated with thrombosis of the superior sagittal sinus, is presented. A thrombectomy of the sinus, followed by skin grafting, was successful in achieving wound closure and a healthy, normal child. We propose that thrombectomy be considered for future similar situations.
A multi-flap design for closure of defects in the inelastic scalp is presented. Two cases are reported, and the advantages of the technique are described. The engineering principle is elaborated and discussed.
A large vascular malformation of the supraorbital and scalp areas was present in an adolescent girl who had seizures and headaches. Removal of the malformation included the outer table of the skull. The patient has had no seizures during a two-year follow-up.
A case of congenital arteriovenous fistula of the forehead and scalp is presented. A review of the embryology, incidence, clinical findings, and diagnostic techniques is discussed along with the various modes of therapy. The ideal treatment of congenital arteriovenous malformation is early, total removal of the tissue involved.
A method of covering lower-extremity wounds using a free fascial scalp flap has been described. The flap provides thin, stable wound coverage, with minimal bulk and an inconspicuous donor site.
We present two cases of traumatic loss of portions of the scalp, one by electrical burn and the other by avulsion. Both patients had large areas of osseous exposure, in which we made use of pericranial flaps taken from the back half of the skull in order to cover the exposed bone. At the same time, local flaps were made and skin grafted over the pericranial flap in a single surgical step using the usual surgical procedures.
It is possible to preserve the ability to grow hair in deep dermal and some full-thickness burns of the scalp by tangential excision and split-skin grafting. The operation should be carried out within a few days of the injury.
A method of approaching the separated, granular temporal scalp wound in a rhytidectomy patient is presented. The time-honored principles of wound healing are discussed with reference to the first skin graft described.
Two representative cases of repair of forehead defects using a modification of the subcutaneous pedicle flap are reported. Complications are minimal if proper technique is followed. Application of this flap to include difficult donor areas, such as the scalp and forehead, should be considered.
The free radial forearm flap provides a reliable single-stage method to cover difficult scalp and forehead defects where other local methods are unsuitable. Six patients have been successfully reconstructed utilizing seven free radial forearm flaps. A description of our surgical technique along with illustrative cases demonstrate the indications and advantages of this flap. Cranial soft-tissue deficits are primarily cutaneous; therefore, a more predictable reconstruction can be obtained utilizing a cutaneous flap with similar characteristics. Restoration of bony defects should be considered separately utilizing autogenous bone and/or alloplastic materials and not merely obliterated with a bulky soft-tissue flap. Therefore, if the local factors of a cranial wound require the utilization of a distant tissue transfer, we prefer the thin coverage of a well-vascularized free fasciocutaneous radial forearm flap over two-stage distant pedicle flaps or skin-grafted free flaps.
Reconstruction of extensive scalp defects represents a difficult problem for the plastic surgeon. In this case report, a successful result was obtained by stretching a dorsal tubed flap with an inflatable balloon placed between the tube and the underlying donor site. This modified tissue expansion has permitted us to transfer an adequate amount of tissue and resurface an extensive area hardly reached by other reparative methods.