Fascia lata graft was placed in 56 (93.33%) patients and
pericranium in 4 (6.67%) patients to cover the defect properly.
The
pericranium and the temporalis muscle must also be left intact while raising the temporoparietal fascial flap so as to allow for skin grafting of the donor site.
Moreover, the surrounding scalp and
pericranium was left intact as a reliable lifeboat in case of minor flap loss or secondary revisions without the need for complex reconstruction or another donor site.
The
pericranium and muscle flap are then closed primarily.
Image 2 shows a stepped dissection of the cranial fascial layers, including the visible layers of the arachnoid mater just superficial to the brain; the dura mater; the bony cranium;
pericranium; galea aponeurotica (with the muscle fibers of frontalis and occipitalis visible anteriorly and posteriorly); and the superficial fascia of the scalp presented continuous with the skin.
(7) A small island of split calvarium was harvested from the posterior midfrontal bone and remained attached to the frontal
pericranium (figure 2, A).
A DHWD involves performing a cruciate opening of the dura and attaching the
pericranium or a dural substitute (Ziai et al., 2003).
(5) In the episteme shared by grammarians (such as Ramus), naturalists (Belon), physiognomists (Porta)--and, I will add, a theologian such as Cajetan--word, nature, and man could all be drawn together in a complex interlocking system of signification, the nodes of which would be marked ultimately by God's signature: "visible marks for the invisible analogies." It is, for instance, no accident that the walnut resembles the human head, for this is the iconic sign given to man that "wounds of the
pericranium" can be cured by the thick green rind covering the shell of the fruit, and so on.
Subgaleal hematoma results from injury to the scalp with subsequent bleeding into the potential space between the galea aponeurotica and the
pericranium. This potential space is vast and can easily accommodate up to half of the blood volume of a neonate.