The scalp is next loosened anteriorly by means of the hands, using
the tip of the cartilage-knife occasionally to nick the fascia and
thus facilitate the working forward of the anterior flap until it
has been loosened as far as the supraorbital ridges anteriorly and
down to the level of the beginning and ending of the incision made
across the vertex. When sufficiently loosened the anterior scalp-flap
is turned over the face, and stretched over the chin, where it will
remain, out of the way, and with both face and hair protected. The
posterior flap of the scalp is then worked back to the same level
at the sides and to the lower border of the occipital protuberance
posteriorly. It is then turned under between the back of the neck and
the wooden block. In stripping the scalp the greatest care should
be taken not to cut or tear off the periosteum. Scars, tumors,
adhesions, traumatic lesions, etc., in the scalp should be carefully
worked out and described as the flaps are loosened. The convex margin
of the fascia of the temporal muscles is now cut with the point of
the cartilage-knife and the muscles are stripped down on both sides
to the level of the folded-over scalp-flaps, where they are either
left hanging down out of the way or are cut off and laid aside. If
they cannot be easily stripped down, they may be scraped off with the
chisel. Some prosectors remove them at the same time with the scalp,
but this is usually not well done. The skull now should be bare,
except for the periosteum, down to the level of a line passing just
above the upper margin of the orbits anteriorly, at the sides just
above the aural opening, and posteriorly just below the occipital
protuberance.
The periosteum is next removed over the entire cranial surface by
means of the chisel, bone-scraper or dull knife. In medicolegal cases
particularly it is of the greatest importance that the periosteum
be removed in this way and the surface of the skull-cap carefully
examined. In ordinary cases the periosteum is often left attached
to the skull-cap when the external examination shows no pathologic
conditions to be present.
Public-domain text, read in full here on John Shaqi.
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