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Title: Title: Surgical management of exposed skull post cutaneous lesion excision of the scalp.


Authors: Dr. Nabil Omair1, Mr. Akinsola Ogunbowale2, Mr. Zoltan Rasko2
Publication: Journal of The Irish Head and Neck Society - 2025
Issue: 3 Volume: 3
Published: February, 2025 View PDF

Background:
Scalp defects can occasionally develop in patients with head and neck cutaneous malignancies leading to exposed skull.

These present a challenging management issue.

Post-operative radiation, local infection, wound dehiscence and previous lesion are the most common reasons for the exposed cranial vault post excision of cutaneous lesions on the scalp.

Various methods have been published about management of scalp defects.

We present cases referred to our department that necessitated surgical management.

All patients presented had malignant cutaneous lesions removed from their scalp, prior to being referred to our department for repair of the exposed skull.

Discussion:
We would like to highlight the complexity of management of scalp defects by presenting these cases, emphasizing how the size of the defect and patient factors influence treatment options.

Exposed cranial vault represents great risk to the patient’s morbidity and mortality, therefore it requires complex care with interdisciplinary input.

The chosen intervention must minimize mortality risk

Advances in plastic surgery, such as free flaps, local and regional flaps, are the primary methods for managing scalp defects.

Local rotational flaps are typically preferred due to logistical considerations, while skin substitutes are also used when appropriately applied, offering satisfactory aesthetic results and good healing integration.

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