Type | Size of defect | Layers involved | Involvement of veins | Treatment | |
Immediate | Late | ||||
0 | Any | Intact epidermis without skin appendages (scarred, hairless area on the scalp) | No | None | |
I | <15 cm2 | Skin defect, no skull bone defect | No | Conservative treatment until complete epithelialization | Hair transplantation, serial excision, or tissue expansion and flap reconstruction, according to final defect size |
II | >15 cm2 | Skull bone defect, exposed dura | No | Conservative treatment until complete epithelialization; emergency coverage may be considered | |
III | Any, usually large | Skin and skull defect with exposed dura and sagittal sinus | Enlarged exposed veins | Emergency coverage with allograft, skin substitute, or autologous skin graft | |
IV | Any, usually large | Skin, skull, and dura defect with brain exposure | Any, usually with enlarged exposed veins | Flap reconstruction |
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