Osteocutaneous bone flap - a useful variant of the osteoplastic flap in pediatric patients

Traditional teaching describes two types of bone flaps in craniotomies - 'free bone flap' and osteoplastic craniotomies. While in the former, the entire bone flap devoid of soft tissue attachments is removed, in the latter the bone flap that is turned is hinged on a pedicle of temporalis muscle with the aim of retaining its vascular supply. We describe a variant of the latter in 13 pediatric patients in whom the lower margin of the craniotomy was above the attachment of the temporalis muscle and where the bone flap was lifted with all the layers of the scalp including the skin and galea, highlighting the thought process behind its performance and the advantages of the same.