Funding sources None.
DERMATOLOGICAL SURGERY AND LASER
Rapid wound healing of scalp wounds devoid of periosteum with milling of the outer table and split-thickness skin grafting
Article first published online: 5 JUL 2012
© 2012 The Authors. BJD © 2012 British Association of Dermatologists
British Journal of Dermatology
Volume 167, Issue 2, pages 343–347, August 2012
How to Cite
Mühlstädt, M., Thomé, C. and Kunte, C. (2012), Rapid wound healing of scalp wounds devoid of periosteum with milling of the outer table and split-thickness skin grafting. British Journal of Dermatology, 167: 343–347. doi: 10.1111/j.1365-2133.2012.10999.x
Conflicts of interest None declared.
- Issue published online: 26 JUL 2012
- Article first published online: 5 JUL 2012
- Accepted manuscript online: 18 APR 2012 01:55PM EST
- Accepted for publication 2 April 2012
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.