Turning A Basic Flap
Different approaches to creating a basic flap to expose the brain
The next step is to join up the skin incisions over the 3 standard burr holes in order to turn a ?-shaped scalp flap (sometimes referred to as a trauma flap). Raney clips can be applied to the scalp edges and the scalp flap reflected and, if necessary, retracted using a couple of stitches and ‘hangers’.
The dura in each burr hole can then be separated from the overlying bone using an Adson dissector or James Macdonald before joining up the holes to cut the bone flap.
The bone can be sawn using a craniotome type drill and footplate, a high speed drill and ‘matchstick’ bit, or a Gigli saw and guide. This is a useful exercise to get to try the various types of saw and compare their relative pros and cons.
Having carefully removed the bone flap without unnecessarily tearing the underlying dura; the dura can then be hitched up around the circumference of the craniotomy by passing sutures through small peripheral holes drilled through the bone: using a fine bit and protective brain retractor underneath.
Finally the dura can be opened, either as a flap or in a cruciate fashion, to expose the brain underneath.
See *NOTE on TECHNIQUES page