Open wounds of the scalp: an account of methods of repair.

Scalp wounds attended by loss of substance are commonly managed either by direct skin grafting or a large transposition flap of adjacent scalp and skin grafting of the donor site defect. Either of these methods has all of the inherent disadvantages of the results of skin grafting: insensate, glabrous surface devoid of hair, recurrent ulceration after minor trauma, and, finally, abnormal appearance. In the past 5 years 23 patients at Emory Affiliated Hospitals have undergone a procedure whereby all existing scalp has been mobilized by fashioning arterialized flaps and the scalp reconstructed with normal hairbearing skin. Multiple relaxing incisions in the galea are requisite to the success of the method. An underlying defect in the bony calvaria can be reconstructed at a second stage by multiple split rib grafts.