Trepanation of the Outer Table as a Treatment for Scalping Injuries: Historical Perspective and Modern Applications.

Complex cranial wounds represent complex surgical problems. In modern times, these are mostly due to accidental trauma. During the period of the American Frontier, violent scalping was a common practice. Innovative techniques were utilized to improve outcomes for this condition that still have relevance in today's practice. We provide a historical perspective with vignettes that identify survivors of violent scalping from the American Frontier as well as the surgical techniques used to treat them. The techniques identified were then modified for modern practice and applied to a complex cranial wound. A review of primary and secondary historical sources was carried out. Nine separate incidences of violent scalping were identified from this period. Successful treatment relied on exposure of the diploe leading to granulation tissue formation and eventual scalp coverage. This was accomplished as a byproduct of the violence of the scalping or as an application of the technique first described by Augustin Belloste in 1696. Application of this technique in a modern setting may allow for improved wound healing. Trepanation of the outer table to aid in healing and closure of complex cranial wounds has a long history of successful practice and can be successfully applied to modern practice.