Undermining of the Scalp: Quantitative Effects

Abstract

The aim of the present study was to evaluate to what extent undermining affects the closing-tension of scalp defects to quantify the surgery-related benefits provided by this procedure. Data were collected by stepwise loading in 10 patients, 20 scalp flaps (obtained by a reversed Y scalp incision), and three different degrees of subgaleal undermining (1, 5, and 15 cm). The obtained data confirmed the value of undermining to diminish the tension on wound margins when closing a scalp defect. There was a progressive decrease in tension required to advance the wound edge when the amount of undermining was sequentially increased. Most of this reduction occurred with the 5-cm undermining, although statistically the 15-cm undermining also resulted in a significant decrease in the tension required to close the defect. Mean 83.3- and 92.2-percent reductions of the closing tension were obtained with 5 cm and 15 cm of undermining, respectively, compared with that achieved by the 1-cm undermining with the same width of defect.

Surgical Management of Deep Brain Stimulator Scalp Erosion without Hardware Removal

“…Traditionally, this would involve debridement of friable scalp edges, undermining of the galea and/or pericranium, and an attempt at mobilizing the local tissues for primary closure. However, even small erosions are subject to increased tension with primary closure, due to the relative inelasticity of the scalp and underlying layers [8,19,20]. Furthermore, once erosion has occurred, further tissue loss following debridement should preclude any additional attempts at primary closure, and a flap should be considered in any subsequent reconstruction.…”

Can we put a simplified algorithm for reconstruction of large scalp defects following tumor resection?

“…There are many options for the reconstruction of large defects. Primary closure either immediate or delayed remains the simplest option with hairy coverage; however it is not easy in cases with large defects which are more than 50 cm 2 [5]. The use of tissue expansion allows a larger area of coverage with satisfactory results, however, it has limitations for size coverage and it is not free of morbidities [6].…”

New technique for releasing tension to prevent widening of an abdominal scar

“…To reduce tension on a suture line, it is useful to use a tensionreleasing suture or a progressive tension suture [1][2][3]. Compared with these methods, the merits of our technique are: advancement of the skin to the medial side according to firm fascial plication; the dissected area is not wide, which reduces the possibility of haematoma or seroma; the body line becomes taut; and the technique is easy.…”

“…To reduce the tension of a suture line, various techniques have been reported [1][2][3]. Although these are useful, we present a new, safer, and easier method by adding plication of the anterior rectus sheath.…”