A Technically Simple and Safe Method for Preparing an Anterior Pericranial Flap Using Saline Injection into the Subgaleal Space: A Technical Note

Abstract Introduction Cranial defects following anterior cranial base surgery have been frequently reconstructed using the pericranial flap. We present a simple technique for preparing the flap using injection of saline into the subgaleal space. Surgical Technique Ten minutes before skin incision, we inserted a 20-gauge needle perpendicular to 8-10 spots in the frontal area and injected 5-7 cc of saline at each spot. Distinctive swelling of the scalp was then observed. After the scalp was incised, the layers were dissected with a monopolar electrocautery device. The layer containing saline allowed us to better localize its exact position and harvest the flap without injury. Dissection in the subgaleal plane was performed mainly using the tip of a surgical blade. After the periosteum was stripped from the calvarium, the flap that had been considerably thickened by saline injection was harvested. Conclusion Since pericranium thickness in the frontal areas is reported to be thinner than other areas, a beginning neurosurgeon may have difficulty harvesting an anteriorly based flap of sufficient size. The technique presented here can help increase awareness of the subgaleal layer (SL), facilitate the dissection process and reduce additional tissue injury via electrocautery manipulation.