|
KMID : 0853020070100020135
|
|
Journal of Korean Burn Society
2007 Volume.10 No. 2 p.135 ~ p.142
|
|
|
Reconstruction of Postburn Alopecia Using Scalp Expansion
|
|
Song Jae-Yong
Jung Hyun-Seok
Park Sung-Wook
Yoon Sung-Won
Kim Jung-Hun
Kim Dong-Chul
|
|
|
Abstract
|
|
|
Backgrounds: Reconstruction of scalp alopecia after burn injuries is one of the challenging procedures, which is essential frequently for the functional and aesthetic improvement of facial deformities of patients who have had severe facial burn. Although primary closure is feasible in small alopecia defects sized cases, the mainstay of treatment involves local tissue rearrangement. To reconstruct the total or partial loss of postburn scalp alopecia, free scalp hair graft or scalp flap, free tissue transfer can be used. In cases of extensive scalp hair loss, the expanded scalp flaps are generally recommended than free scalp graft. We report on the experiences to reconstruct the relatively large sized scalp defects using scalp expansion, which frequently offer more reliable results.
Methods: The 7 patients of moderate to severe postburn scalp alopecia were reconstructed using scalp tissue expansion. 6 of the patients were female and one male. Patient’s age were ranged between 13 and 34. Rectangular shaped expanders with remote valve were used in all cases, and the size of tissue expanders were ranged from 7×4×3 cm to 12×7×5 cm. It is usually recommended to use of rectangular shape of tissue expander to obtain maximal expansion. After choosing the adequate expander size and shape, the scalp skin incisions were designed and made along the marginal area of alopecia. Then the healthy hairy scalp flaps was made in the subgaleal plane until to make the sufficient pockets for tissue expander. The tissue expander pocket was made longitudinally along the lateral healthy hair area adjacent the alopecia area. The remote valve dome for saline injection were located at the subgaleal space internally. During the expansion period, it is mandatory to do maximal expansion over than estimated one. Periodic tissue expansion were done once or twice in a week. And total expansion periods were 2 or 3 months. After completion the expansion, the expanders were removed, and the hair loss area was excised. Then the expanded flaps were transferred by advancement or rotation with design of backcut at flap base or including the small extended triangular shape design at distal lateral portion of the expanded flap, and it covered the defects of scalp.
Results: We have used 12 expanded scalp flaps to reconstruct the postburn alopecia in 7 patients. The scalp defects were caused by flame burn in 6 patients and scalding burn 1 patient. The size of defects of scalp alopecia were ranged from 7×5 cm to 12×10 cm in width and length. The average total length of the expansion period were 2 to 3 months. Major complication, that required to interrupt the expansion process, was an implant removal accompanied suture dehiscence. The major complication rate was 8.3%. Minor complications, were those that did not ceases the expansion process. The minor complications included 2 cases of hematoma, 2 cases of pain, 3 cases of postoperative focal alopecia along the suture sites due to widened operative scars. Minor complications were relatively frequent, and these complications could be managed conservatively. All expanded advancement or rotation scalp flaps were survived completely. The follow up period were 2 weeks to 2 years, and relatively good esthetic results were obtained.
Conclusions: Tissue expansion is one of versatile procedures for postburn extensive scalp alopecia. One of good reason to do this procedures, it usually provides relatively abundant hair restoration in cases of severe postburn scalp alopecia patients. (Journal of Korean Burn Society 2007; 10:135-142)
|
|
|
KEYWORD
|
|
|
Postburn alopecia, Scalp expansion
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|