Scalp

Introduction
The hemorrhage from a scalp laceration or operation is profuse; it area has, the richest cutaneous blood supply of the body. For this reason, extensive avulsions of the scalp are usually viable providing even a narrow pedicle remains attached to the surrounding tissues.

Scalp
Soft

tissue covering the cranial vault It is hair bearing area of the skull Extend from supra orbital margin anteriorly to external occipital protuberance & superior nuchal line posteriorly On each side to superior temporal line

SCALP

S-Skin C-connective tissue (superficial fascia) A-aponeurosis (galea aponeurotica) L-loose areolar tissue P-pericranium

Skin

Thick and hairy Firmly attached to the epicranial aponeurosis through dense fascia Abundance sebaceous glands Sebaceous cyst are common

Skin
The skin of the scalp is richly supplied with sebaceous glands and is the commonest site in the body for sebaceous cysts. A superficial infection of the scalp may spread via this system producing an osteitis of the skull, meningitis and venous sinus thrombosis.

Connective tissue

Fibrous and dense containing blood vessels and nerves Binds skin to subjacent aponeurosis Wounds bleed profusely as blood vessels are prevented from retraction by fibrous tissue. Bleeding is stopped by applying pressure against the bone Subcutaneous hemorrhage are not extensive since fascia is dense Inflammation cause little swelling but are much painful

Aponeurosis

The aponeurotic layer is under tension because of its muscular component and retracts on the underlying loose layer when divided; a gaping scalp wound must, therefore, have extended at least through the aponeurosis.

Aponeurosis

Anteriorly frontal belly and posteriorly occipital belly of occipitofrontalis muscle Frontal belly originate from skin of forehead and mingled with orbicularis oculi muscle Occipital belly originate from lateral 2/3 of superior nuchal line It gaps if cut transversely and should be stitched

Loose areolar tissue

The layer of loose connective tissue beneath the aponeurosis accounts for the mobility of the scalp on the underlying bone; it is in this plane that the surgeon mobilizes scalp flaps, that machinery which has caught on to the hair avulses the scalp and that the Red Indians of bygone days scalped their victims.

Loose areolar tissue

Blood or pus collecting in this loose tissue tracks freely under the scalp but cannot pass into either the occipital or subtemporal regions because of the attachments of occipitofrontalis. Fluid can, however, track forward into the orbits and this accounts for the orbital haematoma that may form a few hours after a severe head injury or cranial operation.

Loose areolar tissue

Extends anteriorly into the eyelids because frontalis has no bony attachment Posteriorly to superior nuchal line On each side to superior temporal line Bleeding cause generalized swelling of scalp

Caput succedaneum

Loose areolar tissue

Called dangerous layer of scalpemissary veins open here and carry any infections inside the brain (venous sinus) Bleeding lead to black eye Caput succedaneum in new born

Pericranium

Is the periosteum of skull Loosely attached to surface of bone but is firmly adherent to the sutures Injury deep to it take the shape of bone (cephalhaematoma) Scalping injury- should be replaced and stitched because healing is better

cephalhaematoma

Caput succedaneum

cephalhaematoma

Blood supply

Arteries

Supratrochlear Supraorbital Superficial temporal Posterior auricular artery Occipital artery

Veins-follows the artery

Nerve supply

In front of auricle

Supratrochlear n. Supraorbital n. Zygomaticotemporal n. Auriculotemporal n. Temporal branch of facial n.

Behind auricle

Greater auricular n Lesser occipital n. Greater occipital n. Third occipital n. Post. Auricular branch of facial n.

Lymphatics

Anterior part
Preauricular

(parotid) gr. of lymph node

Posterior part
Posterior

(mastoid) gr. of lymph node &occipital gr. of lymph node