title: Improved scalp surgery results by controlling tension vector forces in the tissues by galea to pericranium fixation sutures.
abstract: BACKGROUND
  Tension, manifesting at the time of wound closure, limits the extent of tissue excision and predisposes to complications. Extensive undermining may be an unreliable technique to reduce tissue tension in surgery. Pericranium is a rarely used tissue in scalp surgery.
  
  
  OBJECTIVE
  To show that the surgical technique of deep plane fixation reduces tissue tension at and adjacent to the wound, allowing relatively greater excision and reduced tension closure, and extensive undermining may be an ineffectual and potentially harmful surgical technique. I also update the surgical anatomy of the pericranium and determine its utility in scalp reconstructive surgery.
  
  
  METHODS
  More than 1000 scalp operations, including 700 clinical investigative procedures, were done which included pericranial flaps, subgaleal and subperiosteal scalp reductions, and deep plane fixation.
  
  
  RESULTS
  The alopecia removal operation described herein utilizing deep plane fixation is largely complication free and achieves tension-reduced closure and between 18% and 50% greater tissue removal compared with conventional alopecia reduction procedures.
  
  
  CONCLUSIONS
  Pericranium is a valuable and readily usable tissue in reconstructive scalp surgery.
authors.affiliation: Hair Transplantation Clinic of Sacramento, Sacramento, CA, USA. geseery@home.com
authors.forename: G E
authors.initials: GE
authors.lastname: Seery
mesh_terms: D000505:Alopecia / Q000601:surgery*; D006197:Hair / Q000637:transplantation*; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods; D012535:Scalp / Q000473:pathology* / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome