title: The difficult scalp and skull wound.
abstract: Scalp and skull defects can be very difficult to reconstruct. Whereas small defects may require only primary closure, skin graft, or small rotation flaps, large defects involving full-thickness scalp can be much more problematic. These large defects may require free-tissue transfer for adequate soft-tissue coverage. The calvaria also may require reconstruction. If the underlying bone is not infected, it can be left in situ and covered with well-vascularized tissue. The bone should be removed only if it is infected. Calvarial reconstruction should then be delayed for 3 to 6 months. If the tissue has been irradiated, only selected defects are appropriate for coverage with local scalp flaps because adjacent tissues may have underlying damage. With a methodic, accurate assessment of the defect, successful reconstruction can be expected.
authors.affiliation: Department of Surgery, University of Kentucky Chandler Medical Center, Lexington, USA.
authors.forename: S N
authors.initials: SN
authors.lastname: Oishi
authors.forename: E A
authors.initials: EA
authors.lastname: Luce
mesh_terms: D000328:Adult; D001254:Astrocytoma / Q000628:therapy*; D001918:Brachytherapy / Q000009:adverse effects; D003131:Combined Modality Therapy; D003399:Craniotomy; D003646:Debridement; D005260:Female; D005909:Glioblastoma / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011832:Radiation Injuries / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012535:Scalp / Q000473:pathology; D012536:Scalp Dermatoses / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012878:Skin Neoplasms / Q000628:therapy*; D016038:Skin Transplantation / Q000379:methods*; D012888:Skull Neoplasms / Q000628:therapy*; D013524:Surgical Flaps / Q000379:methods*; D014945:Wound Healing