In a dermal graft, hair follicles generally disappear within two months and commonly cause microscopic epidermoid cyst formations which become necrotic and eventually are replaced by fibrosis. But in a deepithelialized flap, the fate of hair
follicles
has not yet been published.
A 45-year old male who had cholesteatoma on his right ear had undergone radical mastoidectomy. The resultant postauricular defect from that surgery, 4×3cm in size, was reconstructed with a deepithelialized scalp flap. Four monhts after the
reconstruction, a 0.5cm diametered opening was found at the suture site, with exposure of regrowing hairs. Then, that deeithelialized flap was removed in a subfollicular plane.
The excised flap revealed regrowing hairs o entire deepithelialized surface. On microscopic examination, tjhere was focal reepithelialization of dermis, even though the major portion was deepithelialized status with marked chronic active
inflammation.
The hair follicles were remained actively and inactively. A number of anagen and telogen phase hairs were found. But about one third of hair follicles were absorbing by foreign body reaction, microabscess, and mico-epidermal cyst formation.
In conclusion, the hair follicles of deepithelialized flap are alive and persist growing although some of them are replaced by fibrotic tissue. Therefore, scalp skin should not be deepithelialized but dissected in a subfollicular plane for
reconstruction of soft tissue.
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