The scalp and forehead have similar structure (Fig 38--). The skin is thick, and over the scalp has abundant hair follicles and sebaceous glands. There is a rich network of blood vessels: the arterial supply to each side of the scalp involves three branches off the external carotid artery (occipital, superficial temporal, and posterior auricular arteries) and two branches from the internal carotid artery (supraorbital and supratrochlear arteries). 7 Since the dermal tissue is so fibrous, vessel retraction is limited following injury, and significant hemorrhage can result. The potential space between the periosteum and the galea aponeurosis allows for easy movement of the scalp over the cranium. However, hematoma and infection can collect and spread within this space to involve the entire forehead and scalp. This high degree of mobility sometimes leads to a scalping injury, in which a large segment of the scalp is torn off in one piece.

FIG. 38-1. The layers of the A. scalp, B. forehead, C. and eyebrow.
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