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PREOPERATIVE ASSESSMENT
PREOPERATIVE ASSESSMENT
Preoperative assessment for scalp wounds is important for several reasons. First, patientsโ diverse aesthetic goals are of critical importance; since function is rarely a primary issue, aesthetics is the key preoperative consideration. In discussing, comparing, and contrasting possible closure options, many patients opt for the less complicated choice. If Mohs surgery is being performed, this information can guide the surgeon on the depth of excision. In a patient preferring a less complicated closure, attempting a more superficial excision may increase options once the cancer is cleared. On the other hand, if a patient favors immediate closure, there may be little advantage to sparing subcutaneous tissue, and excision to fascia is reasonable.
The second important assessment to be made preoperatively is the intrinsic elasticity and mobility of the skin. Scalp skin is typically unforgiving and inelastic. However, some patients do have substantial elasticity and mobility, affording more options for closure, such as adjacent tissue transfer. Preoperative assessment in the outpatient setting is key, as once the skin is infiltrated with local anesthetic, the tissueโs true elasticity becomes more difficult to assess.