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

• Published in: British journal of dermatology (1951) Vol. 167; no. 2; pp. 343 - 347
• Main Authors: Mühlstädt, M., Thomé, C., Kunte, C.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2012; Wiley-Blackwell
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Dermatology; Female; Head and Neck Neoplasms - physiopathology; Head and Neck Neoplasms - surgery; Humans; Male; Medical sciences; Periosteum - surgery; Retrospective Studies; Scalp - surgery; Skin Neoplasms - physiopathology; Skin Neoplasms - surgery; Skin Transplantation - methods; Surgical Flaps; Wound Healing - physiology; Thickness; Healing agent; Scalp; Dermatology; Periosteum; Skin; Cicatrization; Wound
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/j.1365-2133.2012.10999.x

Summary 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.