2. Clinical anatomy scalp.ppt

Scalp

1. CLINICAL ANATOMY OF THE
SCALP
MBChB/BDS/MMED/MDS

2. •Definition
•Anatomy and its clinical aspects

3. Defn / Description
It is the soft tissue covering of the norma verticalis (vault of the
skull)
It extends:
•Posteriorly,from the superior nuchal linesof the occipital bone
•Anteriorly,from thesupraorbital marginof the frontal bone
•Laterally,over the temporal fascia, to the zygomatic arches

4. SCALP
S–SKIN(Layer1)
C–CONNECTIVETISSUE(DENSE)(L2)
A–APONEUROSIS(GALEA)(L3)
L–LOOSECONNECTIVETISSUE(L4)
P–PERICRANIUM(L5)

5. Scalp Proper
•Encompasses layers 1,2,3.
•Considered as one unit

7. Layer 1 -Skin
•It is thick, hairy with numerous sebaceous and sweat glands.
•Obstruction of the ducts of the sebaceous glands by secretions form
Sebaceous cysts.
•Dandruff –dermatology
•Hair transplants

9. Layer 2 –Connective tissue
•It is a fibro-fatty layer which is adherent to the skin and to the underlying
aponeurosis by fibrous septa.
•It is richly supplied with vessels and nerves that run within it. The arteries freely
anastomose with each other. Alternative/collateral blood supply.
•Wounds of the scalp bleed profuselybecause of:
1.The abundant arterial anastomoses.
2.Arteries do not retract when lacerated because they are held open by the dense
connective tissue.

10. Layer 3 –Epicranius and Aponeurosis
•Galea aponeurotica
•Deepscalp wounds gape widely when the epicranial aponeurosisis divided
due to tension of the aponeurosis produced by the tone of the occipito-
frontalis muscle.

11. Layer 4 –Loose connective tissue
Sub-aponeurotic space
•limited in front and behindby
the origins of the occipitofrontalis
muscle
•extends laterallyas far as the
attachment of the aponeurosis to
the temporal fascia
•Has loose areolar tissue with
important emissary veins

12. Importance of layer 4
Dangerous layer:
•Scalp infections can spread through the emissary veins to the intracranial
venous sinuses to cause Venous Sinus thrombosis.
(Emissary veins -valvelessveins that connectthe superficial veins of the scalp with the diploicveins of the skull
bonesand, through them, with the intracranial venous sinuses).
•Blood (sub-aponeurotic haematoma) or pus can spreads to the eye lidsand
the root of the nose because of the attachment of the frontalis into the skin
and not to the bone

13. •“Panda eyes”

14. Layer 5 -Pericranium
•It is the periosteumcovering the outer surface of the skull bones
•At the sutures between individual skull bones, the periosteum on the outer
surface of the bones is continuouswith the periosteum on the inner surface
of the skull bones
•Sub-periosteal/cephalo-haematomas

15. Surgical utility:
Flaps
1: Access:
Coronal flap exposure to access
facial skeleton
Scalp flaps -Neurosurgery

16. 2: Reconstruction:
Flaps –Random/Axial
(vascular anatomy)
Scalp defects
Craniofacial defects: forehead flap,
pericranialflaps (dural/ sinus defects)
****Hair transplants*****

17. THANK YOU