The scalp flap only onlay: a method for managing large dural defects.

The standard approach to loss of substantial amounts of calvarium and dura is replacement of the dura with pathches, usually of biologic material such as fascia. We question the need for such patches and offer experimental and clinical evidence to support a different approach. Treatment of large calvarium and dural defects in 20 rats divided in two groups showed no difference in dural regeneration between animals repaired with patches and those repaired with the scalp flap only onlay on the brain. An illustrative clinical case confirms the observations. The scalp flap only onlay repair of cranial defects involving the dura provides a reasonable means for reconstruction. (1) In experimental animals there appeared to be no histologic difference between dura repaired by autogenous patch and that repaired by the scalp flap only onlay. (2) Clinically, well-nourished galea effects an ideal onlay repair of the dura. Secondary reconstruction of the bony calvarium can be performed utilizing a modified crane technique. (3) The procedure is simple in design, requires no donor sites, and certainly has application in cases other than trauma.