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Introduction
CHAPTER 44 Reconstruction of the
Scalp
David G. Brodland
SUMMARY
Repairs on the scalp may be complicated by relatively inelastic skin and thin
dermis that conspire to make closures challenging.
Secondary and tertiary intention healing are frequent options on the scalp, though
primary linear closure is preferred when feasible.
Beginner Tips
Assess the degree of possible tissue movement prior to local anesthetic infiltration.
Attempt to minimize the volume of local anesthetic infused into scalp skin, and
consider placing direct pressure on the area after infusion to avoid overestimating the degree of tissue inelasticity.
Expert Tips
Superficial excisions on the scalp kept in the suprafollicular plane may heal well via
secondary intention healing.
Fascial transposition flaps may be used as an alternative to hinge flaps to provide a
vascular bed when periosteum has been removed.
Donโt Forget!
Nerve blocks may be helpful in minimizing the volume of local anesthetic used for
select defects.
If a wound fails to show any progress over a 2-week period, assess what is leading to
this stagnation and make changes accordingly.
Pitfalls and Cautions
While dog-ears on the scalp tend to resolve spontaneously, concavities do not.
Therefore, when using split-thickness skin grafts consider tertiary intention healing to provide time for robust granulation tissue, and thus reconstructive thickness, to form.
Patient Education Points
Patients have variable levels of concern regarding scalp aesthetics; be sure to address
this prior to the initiation of surgery.
The scalp healing process may be very time consuming. Patients and their caregivers
should be warned about this well ahead of time, and their willingness to undergo a lengthy wound care regimen must be ascertained.
Billing Pearls
Scalp grafts may be coded with the 15120 and 15220 for split- and full-thickness
grafts, respectively. Xenografts may be coded with 15275.
When repairing a scalp defect with a combination flap and graft, both codes may be
used. Flap codes may not, however, be combined with linear repair codes.
CHAPTER 44 Reconstruction of the