Revisiting Scalp Tissue Expander In Indonesia: Restoration Of Cicatricial Alopecia

Abstract

Background: Scalp alopecia from burn injuries significantly impacts physical appearance and psychological well-being, often leading to social phobia. Tissue expanders have been effective in reconstructive surgeries, offering advantages in restoring hair-bearing scalp areas with excellent color and texture match. However, comprehensive algorithms for their use, particularly in Indonesia, are lacking. Case Presentation: A 10-year-old girl with cicatricial alopecia on the right lateral, frontal, and vertex of the scalp from a burn injury sought reconstructive surgery due to teasing from peers. A 400 mL round silicone expander was implanted and gradually expanded over five weeks. Reconstruction surgery advanced the expanded flap towards the frontal area, improving her hairline. Despite minor necrosis at the flap’s distal margin, which healed by secondary intention, the outcome was favorable. Discussion: This case demonstrates the effectiveness of tissue expanders in scalp reconstruction. Benefits include improved cosmetic outcomes and decreased donor site morbidity, though complications such as infection and alopecia in the expanded tissue require careful management. The underutilization of tissue expanders in Indonesia may be due to lack of insurance coverage and limited local availability. Conclusion: Scalp tissue expansion is a beneficial technique for reconstructing scalp defects, especially in burn-induced alopecia. Wider adoption in regions with limited advanced modalities could significantly benefit patients.