title: A Technically Simple and Safe Method for Preparing an Anterior Pericranial Flap Using Saline Injection into the Subgaleal Space: A Technical Note.
abstract: BACKGROUND
  Cranial defects following anterior cranial base surgery have been frequently reconstructed using the pericranial flap.
  
  
  METHODS
  We present a simple technique for preparing the flap using injection of saline into the subgaleal space.
  
  
  RESULTS
  We inserted a 20-gauge needle perpendicular to 8-10 spots in the frontal area and injected 5-7 mL of saline at each spot 10 minutes before skin incision. Distinctive swelling of the scalp was then observed. After the scalp was incised, the layers were dissected with a monopolar electrocautery device. The layer containing saline allowed us to better localize its exact position and harvest the flap without injury. Dissection in the subgaleal plane was performed mainly using the tip of a surgical blade. After the periosteum was stripped from the calvaria, the flap that had been considerably thickened by saline injection was harvested.
  
  
  CONCLUSIONS
  Because pericranium thickness in the frontal areas is reported to be thinner than in other areas, a beginning neurosurgeon may have difficulty harvesting an anteriorly based flap of sufficient size. The technique presented here can help increase awareness of the subgaleal layer, facilitate the dissection process, and reduce additional tissue injury resulting from electrocautery manipulation.
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Jiwook
authors.initials: J
authors.lastname: Ryu
authors.affiliation: Department of Neurosurgery, National Medical Center, Seoul, Korea.
authors.forename: Sang Bong
authors.initials: SB
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea. Electronic address: nscsk@hanmail.net.
authors.forename: Seok Keun
authors.initials: SK
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Yeongu
authors.initials: Y
authors.lastname: Chung
mesh_terms: D004210:Dissection; D004564:Electrocoagulation; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D019291:Skull Base / Q000601:surgery*; D012965:Sodium Chloride; D013524:Surgical Flaps
chemical_list: D012965:Sodium Chloride
keywords: Anterior cranial base reconstruction; Pericranial flap; Saline injection; Subgaleal layer