Grid Galeal Scoring Technique in Multifocal Calvarial Scalp Reconstruction: Anatomic Basis and Preliminary Clinical Case Applications

BACKGROUND AND OBJECTIVES: Multifocal scalp defects in the calvarial region present a common yet challenging reconstructive dilemma. The inherent high tension in this anatomic region often limits the efficacy of conventional flap repair techniques. Galeal scoring has emerged as a widely adopted intraoperative maneuver for galea aponeurotica release; however, the optimal strategy to safely and effectively enhance its therapeutic efficacy remains undetermined. METHODS: Firstly, 2 fresh cadaveric scalp specimens were perfused with gelatin-lead oxide mixture, layered dissection was performed superficial to the galea aponeurotica to appear the perfused vasculature within the subcutaneous adipose layer. The molybdenum target and transparent processing were performed to delineate the 3-dimensional arterial distribution on the specimens. Secondly, 4 patients with multifocal calvarial scalp defects were surgically managed using the modified grid galeal scoring technique, which the galea aponeurotica was scored in a "grid-like" manner through its full thickness down to the subcutaneous adipose layer. RESULTS: Anatomic dissection clearly delineated the course of major scalp arteries within the subcutaneous adipose layer. All arterial branches were transited from deep into superficial subcutaneous adipose layer, and high-density and continuous vascular network was observed in the calvarial region. All 4 clinical series showed flap survival with favorable wound healing outcomes. CONCLUSIONS: The modified grid galeal scoring combined procedural simplicity with reduced surgical invasiveness, although further clinical anatomic studies and case validations are needed, it remains a pragmatic option for scalp reconstruction.