Surgical Anatomy of the Vascularization and Innervation of the Human Scalp

The arterial, venous, and lymphatic vessels as well as sensory and motor nerves of the human scalp depict a very consistent and stable topographical anatomy. They are organized as “stripes” of neurovascular structures with well-defined medial-lateral and cranial-caudal orientation, whose distribution on the surface of the head and contiguous facial and neck areas can be predicted in relation to the major anatomical bone landmarks of the face and cranial vault in anterior, lateral, posterior, and superior projections. As such, anatomo-surgical dissection of each neurovascular pedicle can be promptly achieved. In addition, two main neurovascular fields can be identified by a frontal plane passing just ahead of the auricles, whose anterior one is provided exclusively by branches of the internal carotid artery (with related veins and lymphatics) and trigeminal nerve whereas the posterior one by branches of the external carotid artery (with related veins and lymphatics) but both the trigeminal nerve and cervical plexus. Finally, the same motor innervation involves both anterior and posterior neurovascular fields, is provided by branches of the facial nerve, and concerns the epicranius muscle.