51 - Management of Postburn Alopecia

Abstract

In extensive burns the scalp may be involved in 25–45% of cases, and deep partial- or full-thickness burns lead to alopecia. Repeated split skin graft (SSG) harvesting from the scalp may also result in alopecia, a risk more common if associated with scalp burns. Alopecia may be a patch of scar, skin graft, nonhealing wound, or an exposed calvarium. Reconstructive options include serial excision, scalp reduction, bipedicle flaps, modified rotation flaps, other local flaps (Juri flap, Orticochea flap), tissue expansion, and hair grafting. Ultimately the best tissue match is provided by local tissues, either by serial excision or by a modified rotation flap template. Tissue expansion generates a local skin flap when none exists. Use of tissue expanders have massively improved the outcomes for reconstruction of large alopecia patches. Losses between 50% and 75% of hair-bearing skin require two expanders placed either simultaneously or sequentially. Areas of more than 75% require camouflage with a wig.