Galeal scoring for salvage scalp closure following cranioplasty failure: a case report

INTRODUCTION: Achieving tension-free scalp closure after decompressive craniectomy or cranioplasty can be quite demanding, especially in patients who have developed fibrosis or infection from previous procedures. In such situations, galeal scoring (galeotomies) can improve scalp mobility. Although this technique is well known in plastic surgery, it is not commonly reported in neurosurgical work. CASE PRESENTATION: A 30-year-old man sustained a high-velocity head injury that produced a large right fronto-parietal acute subdural hematoma with marked midline shift. He underwent an emergency decompressive craniectomy, leaving the bone flap off. After recovery, a delayed cranioplasty was performed using a custom implant, but the wound later became infected, requiring removal of the prosthesis and repeated debridement. As a result, the scalp contracted, and primary closure became difficult. During the final reconstruction, several small galeal-relaxing cuts were made to relieve tension and allow a comfortable closure. OUTCOME: The wound healed completely without further infection. At six months, the patient remained neurologically stable with a satisfactory cosmetic appearance. CONCLUSION: Galeal scoring offers a simple, inexpensive, and safe way to gain additional scalp mobility when closure is tight. It can often prevent the need for complex flap or graft procedures and is worth considering in similar neurosurgical cases.