Authors: Nicholas James Brandmeir, MD; Grant Judy (Morgantown, WV)

Introduction: Traumatic scalp injuries that involve a circumferential injury and devascularization/avulsion of the scalp represent complex surgical problems. These cases are often managed at level I trauma centers with a multi-disciplinary team consisting of trauma, plastic, and neurological surgery. The historical example of scalp-taking along the American frontier presented a unique medical challenge where many these complex wounds were treated by surgeons with minimal resources, even for that era. We examine the historical development and propagation of a novel technique for the treatment of these wounds. Methods: A literature review was conducted on the history of scalping along the American frontier as well as medical treatments available. Primary sources and accounts as well as historical articles were reviewed for descriptions of surgical procedures used to treat scalping injuries. Results: French surgeon Augustin Belloste published his technique for trepanation of the outer table in the early post-injury phase in 1696. His method spread to the Netherlands, where it is found in the teachings of Boerhaave. From there it spread to Scottish surgeons, some of whom traveled to America. By the middle and end of the 18 th century the technique was applied widely across the frontier from Ft. Pitt to Tennessee. Conclusion: Trepanation of the outer table is an effective technique for the treatment of circumferential avulsions of the scalp that remains relevant today. It was applied successfully over a wide area of the American frontier until the closing of the frontier in the late 19 th century.