(1) Although computed tomography is a useful diagnostic adjunct, its availability should not be a sine qua non for forward neurosurgery. (2) The current Kevlar helmet design appears successful.

Dehiscence of cervicothoracic incisional wounds is an occasional complication of laminectomy. Subsequent healing can be further compromised by associated immunodeficiency, malignancy, infection, previous radiotherapy, and cerebrospinal fluid fistula. Two such cases that responded dramatically to the use of a lower trapezius muscle flap are described. Pertinent anatomical and surgical considerations are reviewed.