Correction of facial linear scleroderma ‘coup de sabre’ with BoneSource ®

Abstract

Linear scleroderma is a subtype of localised scleroderma. When linear scleroderma occurs on the anterior portion of the scalp and forehead, it may assume an ivory-like, depressed configuration similar to the stroke of a sabre and called 'coup de sabre'. Atrophic changes affect subcutaneous tissue and skin, with later involvement of the muscles and osteocartilaginous framework. Various operative interventions, such as skin flap, fat graft, dermofat graft and bone graft could be used for correction of this deformity, but there is no definite satisfactory treatment modality. We report the case of a 19-year-old female with a band-like indurated skin lesion with depression in the frontoparietal region of the scalp. Through bicoronal incision and subperiosteal dissection the defect was fully exposed. The depressive lesion was slightly hyperaugmented using BoneSource (calcium phosphate hydroxyapatite cement; Stryker Leibinger Corp., Kalamazoo, MI, USA), considering skin and soft tissue atrophy. Surgical outcome was excellent in cosmetic and functional aspects without any complication. The patient was followed for 36 months after the operation; the defect was satisfactorily corrected and no postoperative problems have been found.