Skin incision

The decision to select a specific incision would depend on several aspects e.g. surgical site, related anatomical structures, easy access, fewer complications, quicker healing, and minimum scar. But, in some instances, all these options might not be fulfilled and the surgeons have to make a professional judgment to decide on what's best for the patient's condition.

The marking of the skin incision is done so that its two endings form an imaginary straight line that adequately simulates the separation of the skin flap and the consequent bone exposure

Plan your incision!

o Clip fur at least 15 cm wide of incision

o Permanent marker prior to prep or sterile marker after draping (if needed)

o If possible, follow lines of tension (the final closed incision will be on/parallel to a line of tension)

o Do not create a “biological tourniquet” with closure; it is better to leave it open a centimeter or so…it is not a “failure” it is a “rational plan”.

Bicoronal skin incision for bifrontal craniotomy.

Kempe incision

Temporal skin incision.

Question mark incision.

Reverse question mark incision.

Retroauricular incision.

The entrainment of air typically occurs during bone work, but Spence et al. describe a case in which a venous air embolism (VAE) was recognized while working on the scalp. Monitoring techniques are critical for early treatment of VAE to avoid more serious complications, and our case illustrates the need to implement monitors early and remain vigilant throughout the procedure 1).

Spence NZ, Faloba K, Sonabend AM, Bruce JN, Anastasian ZH. Venous air embolus during scalp incision. J Clin Neurosci. 2016 Jan 4. pii: S0967-5868(15)00659-1. doi: 10.1016/j.jocn.2015.11.019. [Epub ahead of print] PubMed PMID: 26765767.
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