====== Skin Flap ======
The [[assessment]] of the skin [[flap]] above [[cranial defect]]s (SCD) following [[craniectomy]] is routine in neurosurgical practice, and a change in the consistency of the [[skin]] flap may indicate [[raised intracranial pressure]] or the occurrence of a [[complication]] necessitating intervention. The [[purpose]] of a [[study]] of Schwarz et al. from  [[Jena University Hospital]], and [[Vivantes Klinikum im Friedrichshain]], was to develop a clinically useful [[classification]] system based on clinical assessment of the degree of skin flap bulging or sinking and its firmness.

This was a [[prospective]] [[single center study]]. The SCDs of consecutive patients who underwent craniectomy were assessed daily by two trained independent examiners. The consistency of the flap and its bulging or sinking in comparison with the level of the [[cranium]] were noted. Testing conditions including the [[position]]ing of the patient and examiner were standardized.

A total of 520 examinations were conducted in 24 patients during their hospital stay. There was 100% interrater reliability (Cohen's κ = 1.0). In 66.6% of all patients (n = 16/24), a change of the SCD classification in comparison with that recorded on the previous day was noted.

The SCD classification facilitates the reproducible and objective assessment of SCDs, enabling reliable monitoring over time and between individuals
((Schwarz F, Simon M, Lawson McLean A, Kalff R, Waschke A. Assessment of Skin
Flaps Above Cranial Defects Following Craniectomy: A Proposed Classification
System. J Neurol Surg A Cent Eur Neurosurg. 2019 Oct 7. doi:
10.1055/s-0039-1696996. [Epub ahead of print] PubMed PMID: 31590193.
)).