Immediate coverage of exposed, denuded cranial bone with split-thickness skin grafts

Avulsion injuries of the scalp are challenging to treat. If the periosteum is not intact and the status of local tissues does not allow local flap transposition, coverage of the exposed, denuded skull becomes a problem. Most authors have obtained a bed of granulation tissue at the site of exposed bone before skin grafting, which requires a prolonged waiting period. In 5 consecutive patients, the authors obtained coverage in a single operation by removing the outer table of the skull with a high-speed burr, followed by immediate application of a skin graft over the bleeding, cancellous bone. This resulted in stable coverage and shortened the hospital stay significantly. They describe their technique and compare it with others.