Rapid wound healing of scalp wounds devoid of periosteum with milling of the outer table and split-thickness skin grafting

M Mühlstädt, C Thomé, C Kunte
British Journal of Dermatology 2012, 167 (2): 343-7

BACKGROUND: Excision of large scalp tumours may result in exposed bone devoid of periosteum. The resultant surgical defects may be too large to close by either primary closure or local cutaneous flap. The denuded bone usually precludes the immediate placement of a skin graft.

OBJECTIVES: To describe our experience with milling the outer cortical table of the skull in order to promote granulation and hasten wound healing.

METHODS: In 11 patients, we expanded existing techniques of exposing diploic veins in the cancellous bone by completely milling the exposed outer table of the scalp bone with a rose head burr driven by a pneumatic power drill. After induction of punctate bleeding a split-skin graft was placed in the same session and secured with a tie-over foam dressing. Dressing was removed 7 days after surgery. All patients received perioperative antibiotics. Informed consent was obtained prior to the procedure.

RESULTS: In all 11 patients a healing of the split-thickness skin graft was observed within 1 week.

CONCLUSIONS: The combination of extensive exposure of cancellous bone and an immediate split-thickness skin graft reduces convalescence time from multiple weeks to 7 days. This is beneficial in older patients sparing them from frequent visits to the doctor. Furthermore, early closure may reduce the risk of infection.

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