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Craniocerebral injuries present themselves, at times, as both a neurosurgical and a plastic problem the solution of which should be accomplished at the initial operation. Intracranial injuries not infrequently are accompanied by partial evulsion and devitalization of the scalp. Probably more scalp tissue is excised during the débridement than is lost by evulsion; however, despite the notorious viability powers of the scalp one can compromise but little when dealing with partially or completely devitalized scalp tissue. The size of the resultant scalp defect ceases to influence the thorough débridement when rather simple plastic procedures are available.
The inelastic character of the scalp is due to the short fibrous septums, which form an inelastic subcutaneous layer and which bind the skin firmly to the galea. However, beneath the galea, the subepicranial space is filled with loose connective tissue. Any form of relaxing incision in the scalp which reaches only as deep
BALKIN SG, DOWMAN CE, KLEMPERER WW. THE MANAGEMENT OF EXTENSIVE SCALP DEFECTS IN CRANIOCEREBRAL INJURIES. JAMA. 1945;128(2):70–72. doi:10.1001/jama.1945.02860190006002
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