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Surgical pearl
An efficient single-layer suture technique for large scalp flaps

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Surgical challenge

Defects of the scalp after surgery can present a reconstructive challenge due to the inherently low elasticity of the scalp. Scalp rotation flaps are used for reconstruction of scalp defects that are not amenable to primary closure, second intention, or skin grafts.1 Suturing scalp rotation flaps over large defects can be difficult and time consuming for complete closure and hemostasis.

The solution

We suggest a simplified, single-layered closure for scalp rotation flaps that negates the necessity of time-consuming, double-layered closures. This technique can be executed using 3-0 polyglactin 910 (Vicryl; Ethicon, Somerville, NJ) with an RB-1 needle. It is a strong, braided suture that typically would be used for deeper layer closures and easily slides with pulley techniques without breaking, allowing large tight flaps to move while distributing tissue vectors. The RB-1 needle has a

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Funding sources: None.

Conflicts of interest: None disclosed.

Reprints not available from the authors.

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