Cadaveric Split-Thickness Skin Graft With Partial Guiding Closure for Scalp Defects Extending to the Periosteum

A scalp defect that extends to or below the periosteum often poses a reconstructive conundrum. Achieving the level of tissue granulation necessary for secondary-intention healing is challenging without an intact periosteum; surgeons often resort to complex rotational flap closures in this scenario. For tumors at high risk for recurrence and in cases in which adjuvant therapy is necessary, tissue distortion with a complex rotational flap can make monitoring for recurrence difficult. Similarly, for elderly patients with substantial skin atrophy or those in poor health, extensive closure may be undesirable or more technically challenging and poses a higher risk for adverse events. Additional strategies are necessary to optimize wound healing and cosmesis. Granulation and epithelialization of wounds can be expedited using a cadaveric split-thickness skin graft (STSG) of biologically active tissue. We describe this technique and show its utility in cases in which there is concern for delayed or absent tissue granulation, or when monitoring for recurrence is essential.