This document describes using trephination and platelet-rich plasma (PRP) to treat full-thickness scalp defects. Trephination involves drilling small holes in the calvarium down to the spongeous bone layer. PRP is then applied, which contains growth factors that promote granulation tissue formation. Over time, the granulation tissue expands to cover the defect, allowing for skin grafting. The document presents a case study of a man who underwent trephination with PRP to treat a large scalp avulsion injury, with the granulation tissue achieving full coverage within two weeks to enable skin grafting. While more data is needed, the authors believe PRP may help stimulate granulation formation for reconstructing scal

1. BACKGROUND
using trephination to create holes to the depth of the
spongeous layer followed by grafting once granulation has
covered all defects is an important reconstruction alternative.
full-thickness partial scalp defect -> holes drilled to the
spongeous layer by trephination with PRP.

2. METHOD
Traumatic loss of the whole-layer scalp, the priority is to
cover the exposed bone on the calvarium as soon as
possible.
• local flaps from the hairy scalp
• neighboring periosteum flaps and skin graft
• transplantation of far flaps using microsurgery

3. ALTERNATIVE
• creating holes with trephination reaching the spongeous
layer and grafting the developing granulation after it
covers all of the defects is an important reconstruction
alternative [1,2]

4. CONS
★ Formation of granulation and its covering of the whole defect
trough expansion is a slow process.
★ creating numerous holes
★ temporary skin graft
★ various wound dressing / eg: NPWT -VAC/

5. AUTHORS
TREPHINATION PRP

6. CASE
Traffic accident, a 43-year-old male patient with
multiple traumas:
- bilateral pneumothorax
- pneumocephalus
- 10 cm by 8 cm full-layer scalp avulsion
/ frontoparietal compound and, including the parietal
region middle line/

7. CASE

8. TREATMENT
Trephination: 6*1.5cm
PRP: - twice on the day of operation and again one
week later.
Gauze soaked in saline was used as the dressing.

9. PRP contains:
- platelet-derived growth factor (PDGF)
- transforming growth factor b (TGF-b)
- insulin-like growth factor (IGF)
- epidermal growth factor (EGF)
- fibroblast growth factor (FGF)
- bone morphogenic protein (BMP).
PRP's effects on bone grafts and bone healing, defect
healing and development of granulation is well researched
but there is no research on granulation rooting from the
spongeous layer.

10. CASE

11. CASE

12. CASE

13. PROS
trephination is a simple process
is that the exposed bone should be well
protected with a dressing

14. CASE

15. CASE

16. DISCUSSION
• Calvarial bones have good circulation, and they can intake grafts even while
denuded.
• However, it is not recommended to apply grafts directly onto the exposed bone
due to reduced stability of the graft and the rate of success.
• It is possible to graft the calvarial bones after removing the outer cortex, at that
moment or after allowing granulation to occur, and then proceeding to grafting.
But removing the outer tabula will cause thinning of the calvarial bone and loss
of bone durability.
• Drilling small holes will result in a sturdier calvarium after the operation. Thanks to
favorable circulation, the rising of granulation through the holes and covering the
denuded areas around the defect requires only a few weeks.
• Though this period is reported to last between 2 and 3 weeks, it cannot be expected
to be the same in younger and older patients.

17. DISCUSSION
• Authors used PRP in order to induce granulation in their patient.
• In two weeks, authors acquired granulation that completely covered the
scalp defect and then we covered it with a skin graft.
• Authors weren't able to accumulate enough data to demonstrate its effect
on granulation with a single trial. However, PRP secretes growth factors
which stimulate inflammation, bone and cartilage formation, collagen
formation and neoangiogenesis. They believe PRP is beneficial in this
area.

18. AGAPE CASE
Electric burn injury:
Patient L, M32

19. CONCLUSION
• In cases of total or partial scalp defects where the calvarium is exposed,
if the methods that give better cosmetic results cannot be used, then
drilling holes into the spongeous layer using trephination and
acquiring granulation in order to graft the area later is an excellent
alternative for patients of all ages.
• Applying PRP into the holes in the form of gel or drops may have a
positive effect on the formation of granulation and its expansion over
the exposed bones around it.
• Dressing of the scalp defect area properly is VERY IMPORTANT.
• INFECTION!!!
• SIZE and QUANTITY of holes!!!
• DECISION MAKING!!!

20. THANK YOU FOR YOUR ATTENTION ^^
ANY QUESTION OR COMMENT, PLEASE?