Closure of the calvarial bone graft donor site precedes the facial soft-tissue resuspension and galea and scalp closure at the end of the skeletal reconstruction.
The donor site is covered with a hemostatic material if required.
If available, the pericranium is sutured over the donor site.
Resuspension of the facial envelope
To prevent ptotic soft-tissue deformities resulting from degloving, several resuspension measures are recommended to restore the facial ligaments and septae prior to skin closure. The resuspension resembles a subperiosteal face lift procedure and is done in the following order (according to what is individually applicable):
Lateral canthopexy (A)
Refixation of the temporal muscle (B)
Refixation of the superficial layer of the temporalis fascia (C)