The subgaleal space between the galea aponeurotica and the pericranium (periosteum of the skull vault) contains loose areolar tissue and potential bursal spaces that allow the scalp to move freely over the skull. This layer is the surgical plane for scalp flap elevation and the route of spread for subgaleal haematomas.
The subgaleal space is the site of subgaleal haematoma in neonates (caput succedaneum variant), which unlike cephalhaematoma crosses suture lines and can hold the entire neonatal blood volume. In adults, subgaleal haematoma from blunt trauma or anticoagulation may produce dramatic scalp fluctuance extending from the orbital ridges to the occiput. Subgaleal abscess from scalp infection can track widely and spread to the intracranial compartment via emissary veins.
Blood collection in the subgaleal bursal space crossing suture lines and potentially involving the entire scalp vault, causing significant haemorrhage in neonates and anticoagulated adults.
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