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. 2023 Feb 22;15(2):e35301.
doi: 10.7759/cureus.35301. eCollection 2023 Feb.

The 1-2-3 cm Advancement Flap Rule in Scalp Reconstruction

Hani Shash  1 , Sawsan Marzouq  1 , Abdulrahman Alghamdi  2 , Majd Alrayes  2 , Saud K Alkhaldi  2 , Hayam Shash  1 , Ahmed M Abu Quren  2
Affiliations

The 1-2-3 cm Advancement Flap Rule in Scalp Reconstruction

Hani Shash et al. Cureus. .

Abstract

Background Defects of the scalp are surgically challenging for several reasons: anatomical convexity limits tissue displacement, resistance to advancement is different at different points on the scalp, and there is also interindividual variation. For many patients, the idea of undergoing an advanced surgery such as a free flap is not preferred. Hence, a simple technique with a favorable outcome is needed. We hereby introduce our new technique: the 1-2-3 scalp advancement rule. Objectives The objective of this study is to discover a novel way to reconstruct scalp defects secondary to trauma or cancer, without having the patient undergo a big procedure. Material and Methods A total of nine cadaveric heads were used to test the idea of achieving greater advancement and increased scalp mobility to cover a 4×8 cm-sized defect using our proposed 1-2-3 scalp rule. Three steps performed were advancement flap, galeal scoring, and removal of the outer table of the skull. The measurement of advancement was recorded after each step, and the results were analyzed. Results The mobility of the scalp was calculated from the sagittal midline with identical arcs of rotation. With zero tension, we found that the total distance of advancement with a flap had a mean of 9.78 mm, while the advancement for the same flap after galeal scoring had a mean of 20.5 mm, and after removing the outer table, the mean advancement was 30.2 mm. Conclusion To create a tension-free closure necessary for optimal outcome for scalp defects, our study showed that increased distances were possible using galeal scoring and outer table removal, increasing the distance of advancement by 10.63 mm and 20.42 mm, respectively.

Keywords: galea score; plastic surgery; scalp defects; scalp reconstruction; tissue expansion.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Advancement made without galeal scoring or burring of the outer table
Figure 2
Figure 2. Advancement made with galeal scoring
Figure 3
Figure 3. Advancement of 3 cm made after the removal of the outer table
Figure 4
Figure 4. Incisions of the galea at 1 cm intervals
Figure 5
Figure 5. Removal of the outer table to further increase the advancement flaps
See this image and copyright information in PMC

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