Expanded Scalp Flap Research Articles

Hair follicle extraction combined with an expanded scalp flap for facial organ reconstruction

Use of scalp skin for facial organ reconstruction represents a mainstream procedure for organ reconstruction. In most cases, adequate amounts of skin can be obtained by using tissue expanders, but harvesting sufficient scalp tissue in patients with low hairlines is challenging. Hair follicular unit extraction (FUE) is one approach to resolve this problem. With FUE, hair follicles are removed from the scalp skin, which can then be prepared as a donor site to obtain sufficient amounts of hairless skin. To evaluate the safety and efficacy of FUE when combined with an expanded scalp flap for facial organ reconstruction. Patients with low hairlines requiring facial organ reconstruction were selected for this study. The area of skin extension and hair removal were determined prior to surgery, a process which was performed in three stages. Stage I consisted of hair follicle removal using the FUE technique at the donor site. Stage II involved expander implantation using water injections. In Stage III facial organ reconstruction was completed. With the use of the FUE technique, hair follicles from the donor scalp were thoroughly removed and the donor scalp tissue was successfully expanded. Postoperatively, no evident scar formation at the reconstruction site or contracture of the expanded flap was observed. All patients were satisfied with the outcome of their reconstruction procedure. FUE provides a means for hair follicle removal from the donor site and can be employed to achieve a safe and effective procedure for facial reconstruction in patients with low hairlines.

Macrophage contribution to the survival of transferred expanded skin flap through angiogenesis.

Despite the application of tissue expansion in the reconstruction of significant tissue defects, complications with expanded random-pattern skin flaps remain a major challenge. Insufficient angiogenesis is one of the keys factors in flap ischemia and dysfunction. Macrophages play a key role in promoting tissue angiogenesis, but their effects on expanded flap angiogenesis and the survival of the transferred skin flap are still unknown. A rat scalp expansion model was established to evaluate the dynamic changes of macrophages in expanded skin. Clodronate liposomes (Clo-lipo) were injected into the expanded scalps to deplete the macrophages, and the expanded scalp flaps with macrophage depletion were orthotopically transferred. The remaining expanded rat scalp flaps were treated with either a macrophage-colony stimulating factor (M-CSF) alone or M-CSF in combination with Clo-lipo and transferred. The number of macrophages, blood perfusion, microvascular densities (MVDs), flap survival, histological changes, and gene expression related to macrophage polarization and angiogenesis were determined with immunofluorescence (IF) staining, full-field laser perfusion imager, hematoxylin and eosin (HE) staining, and quantitative real-time polymerase chain reaction. The number of pan-macrophages significantly increased in the expanded scalp on days 14 and 21 after expander placement. The depletion rate after treatment with Clo-lipo was 29.06%, and the number of macrophages was significantly reduced in the group that underwent Clo-lipo treatment on day 14 before flap transfer (P<0.05). Macrophage depletion resulted in decreased blood perfusion, reduced MVDs, lower expression of factors, and poor survival rate. The recruitment of macrophages with a M-CSF led to higher blood perfusion, increased MVDs, greater expression of angiogenic factors, and better flap survival after flap transfer. Alternatively activated macrophages in the expanded flap could significantly promote angiogenesis, improve blood perfusion, and ultimately increase the flap survival rate. Modulating alternatively activated macrophages may provide a key therapeutic strategy to promote expanded skin flap survival. Our study has provided a basis for clinically improving random-pattern skin flap survival.

The Efficacy of Anterior Capsulotomy and Basal Capsulectomy Adherent to Expanded Scalp Flap During Alopecia Reconstruction in Pediatric Burned Patients.

Scalp expansion is an optimal treatment for alopecia resulting from burn injuries, especially in the pediatric population through providing highly vascularized adjacent local tissues with optimal hair density, color matching, texture, and hair-bearing characteristics. The aim of this study was to evaluate the efficacy of anterior capsulotomy and basal capsulectomy adherent to expanded scalp flap during alopecia reconstruction with scalp expansion in pediatric burned patients. The study was conducted on 127 patients with an age range of 5 to 19 years who presented with postburn alopecia accompanied by hairline loss. The patients were divided into 2 groups: group I consisted of 58 patients who were operated on using conventional technique, and group II consisted of 69 patients who were operated using modified technique including basal capsulectomy on the skull side and anterior capsulotomy on the expanded scalp flap. The Hairdex, a validated questionnaire of Hair-Specific Health-Related Quality of Life measures, showed that percentage of satisfaction concerning outcomes was 91.50%, psychological well-being was 95%, and self-confidence was 84.30% in group II, compared with 63%, 55.70%, and 66.20%, respectively, in group I. This significant values had a great positive effect on patient satisfaction, changing child's behavior and self-confidence. Although physiological background of tissue expansion is the same, proper flap design with anterior capsulotomy on flap undersurface and basal capsulectomy on the skull side improve results of the traditional method significantly and minimize the complication rate. These surgical modifications provide maximum benefits from expanded tissue, with restoration of the hairline and a uniform hair direction. Level III, case-control study.

Aesthetic Sideburn Reconstruction Using an Expanded Hair Bearing Skin Flap With Natural Hairline.

Hairline is the marginal line of hair growth on the scalp. Patients with sideburn defects, caused by tumor resection, severe infection, or burns, might have low self-esteem and mental stress. The purpose of this article was to explore a surgical method of applying the expanded scalp flap with natural hairline for cosmetic reconstruction of hairline, so as to provide reference for future clinical work. In this study, a retrospective analysis was conducted on 23 patients in the plastic surgery ward of the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from January 2015 to December 2018, who underwent expanded scalp flap cosmetic reconstruction of the sideburns with natural hairline (14 males and 9 females; average age, 18.7 ± 13.7 years). The follow-up time was 8 to 44 months. Patient satisfaction rate (scored 4 or more) was 95.7%, with an average score of 4.59. A total of 16 patients were very satisfied, and 6 were satisfied. There were 21 patients who had good flap survival, and 2 patients who had venous congestion at the distal end of the flap. One case relieved voluntarily 3 days postsurgery, and the other case had partial skin necrosis at the distal end, healing phase II. These 2 cases were classified as grade I according to the Clavien-Dindo classification. In 9 of the patients, the reconstructed sideburn presented a natural look with good hair angle and great size and shape, with average scores of 4.61, 4.52, and 4.48. The scars at the donor site were inconspicuous, and there were no complaints (average score, 4.61). The rest of the patients received satisfactory appearances after surgery. In conclusion, the technique described above presented a fine method for sideburn reconstruction. Based on the achieved aesthetic scores of our study, as well as the high patient satisfaction rate (95.7%), the aforementioned technique is acceptable for both surgeons and patients.

Hair-Bearing Expanded Scalp Flap for Total Beard Reconstruction in Patients With Chin and Submental Postburn Scars.

Loss of beard in adult male caused by severe burn may cause cosmetic and psychological problems for these patients. Reconstruction of the beard with hair-bearing skin flaps in similar color and texture of the surrounding tissues remains a challenge. Eight male patients suffered from submental postburn scar and beard loss were treated by using the hair-bearing expanded scalp flap. A 1000mL nephroid tissue expander was first implanted under the frontal and mid scalp. After a 3 to 4-month tissue expansion, the expanded hair-bearing scalp flap based on bilateral superficial temporal vessels were raised and transferred for beard reconstruction, and the cutaneous pedicles were curled into tubes. Delay and division of the pedicles were performed 3 to 4 weeks after flap transfer. Eight male patients with postburn scar and beard loss were successfully treated with no major complication. One patient suffered from edge necrosis at distal end of the flap and healed after daily dressing change. Chin and submental areas were repaired by expanded scalp flap and total beard was reconstructed at the same time. All donor sites were closed directly without skin grafting. The modified expanded bipedicled scalp flap provides an easy and reliable way for total beard reconstruction and large-scale submental scars repairment.

Reconstruction of facial defects using a pre-expanded scalp flap: A description of the method used and outcomes of 43 patients.

BackgroundA technique for reconstructing facial units with matching colour, similar texture and sufficient contour is ideal for patients with various facial defects. The current report aimed to present the experience of the authors in facial reconstruction using pre-expanded scalp flaps combined with laser hair removal.MethodsFrom January 2014 to August 2021, 43 patients with different facial defects, such as post-burn scar and congenital nevus, were treated using this surgical technique that involved tissue expansion, scalp flap transfer and laser hair removal. Facial defects were artificially classified into three regions (forehead, n = 19; cheek, n = 15; and lips and chin, n = 9). Pedicle delaying and division were performed in patients who underwent reconstruction with pedicled flaps.ResultsOf the included patients, one presented with haematoma, one with infection and three had distal necrosis after expanded scalp flap transfer. The donor site was primarily closed in all patients. Further, all patients were successfully treated without major complications. The texture, colour and contour of the scalp flap after laser hair removal matched well with the surrounding skin tissues at 2–30-month follow-up.ConclusionReconstruction using pre-expanded scalp flaps combined with laser hair removal is an effective and reliable option for facial reconstruction with excellent colour and texture match.

Reconstruction of Facial Multiunit Defects Using Expanded Scalp Flap with Laser Depilation in a Group of Predominantly Pediatric Patients.

Background: The cervical or thoracic region is currently the main donor site for repair of facial multiunit defects (FMUDs); however, its extensive clinical utilization encompasses the need for flap prefabrication and microsurgical techniques. Objective: To illuminate the feasibility of treating FMUD with expanded scalp flaps and laser depilation. Methods: From 2016 to 2020, 17 patients with facial giant congenital melanocytic nevi (GCMN) underwent scalp expansion for FMUD reconstruction. A three-stage surgical treatment plan was attempted and laser depilation was scheduled during the expansion period and postrepair surgeries. Results: All the flaps survived successfully and were able to cover the entire facial defect. The average three-stage treatment time was 4.5 ± 1.3 months. The defect sites included the forehead, nose, cheek, temporal, and eye areas. The maximum defect area was 9 × 30 cm. The average number of laser treatments was 4.6 ± 2.9 times. The average treatment period was 26.8 months. Sixteen patients (94.1%) reported satisfactory outcome. Conclusion: Expanded scalp flap combined with laser depilation is feasible for FMUD repair and warrants further investigation. Clinical Trail Registration Information: Translational Medicine Ethics Review Committee, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine (SH9H-2021-T144-3).

Expanded scalp flap combined with laser hair removal to reconstruct facial defects around the hairline

Congenital and acquired facial lesions around the hairline can bring huge physical and psychological trauma to patients. At present, reconstruction of this area remains a challenge. In this study, we present an alternative technique to reconstruct the aesthetic units using an expanded scalp flap combined with laser hair removal. We retrospectively reviewed 25 cases of facial lesions around the hairline reconstructed with this surgical technique between May 2014 and May 2020. Expander was implanted under the scalp as designed before the operation. After the expander was fully expanded, the lesion was removed and the scalp flap was transferred. Laser hair removal was performed on the transplanted skin flap 2 weeks after flap transfer. There were ten cases of postburn scar, nine cases of congenital nevus, four cases of traumatic scar, one case of haemangioma, and one case of nevus sebaceous. The median times of laser treatment was 3 (range, 1-8). The median follow-up time was 11 months, ranging from 1 to 27 months. The colour and texture of expanded flaps were similar to adjacent tissue in all cases. The direction of reserved hair in transferred flaps was consistent with the direction of hair in the recipient area or contralateral hair. There were no complications, such as infection, blistering, discolouration, and ulceration. All patients were satisfied with the appearance of the reconstructed hairline and the surgical outcomes. The expanded scalp flap combined with laser hair removal is a feasible and effective technique to reconstruct both sides of the hairline simultaneously from a single donor site with a good colour match and a similar texture and thickness.

Prefabricated Expanded Flap Combined With Expanded Scalp Flap for Total Face Resurfacing.

Reconstruction of total facial deformities and defects has been a major challenge of reconstructive surgery. Allotransplantation is limited by the number of donors and the need for life-long immunosuppression. Autotransplantation, where multiple autogenous tissue grafts from various donor sites are used to repair facial defects, inevitably leaves conspicuous patchwork scars. A prefabricated monoblock flap, although the preferred treatment modality, is limited by insufficient blood supply and the large size of the flap. In the Journal of Craniofacial Surgery (2014;25:21-25), Li et al applied the technique of flap prefabrication and stem cell-assisted tissue expansion to reconstruct total facial injuries, but the operations were complicated and the final expanded flap area was also uncertain. This article introduces an approach to reconstruct total facial injuries with a prefabricated expanded thoracic flap combined with an expanded scalp flap (called combined flaps), which not only solves the limitations of blood supply and expanded volume but also reduces patchwork scars. The approach is a simple, feasible, and effective surgical method for total face resurfacing.

Using an expanded scalp flap without fascial flap harvest or skin grafting for total auricular reconstruction in hemifacial microsomia with low hairline

BackgroundTotal auricular reconstruction for hemifacial microsomia patients with extremely low hairline is a tough challenge in plastic surgery. In this work, a brand new technique using a singer expanded scalp flap without skin graft and combined with intense pulse light treatments (IPLT) for ear reconstruction is described in this special population. MethodsFrom January 2015 to April 2019, 41 hemifacial macrosomia (HFM) patients with 70–100% low hairline were enrolled in our study. Operative treatment was performed in 3 stages: 1. Expander insertion and inflation; 2. Expander removal, costal cartilage framework fabrication and auricular reconstruction; 3. Tragus reconstruction and reconstructed auricle refinement. Several IPLTs were performed every 45 days until local area become hairless during the whole course. The first IPLT could be executed either before all the operations or during the expansion period. The flap was treated with M22 system using a filter of 695–1200 nm. Follow up ranged from 10 months to 4 years. ResultsDuring follow-up, 90.2% patients were surveyed as satisfied with the outcome, especially in the aspects of minimal scars, natural matched color and clear contour of the reconstructed ear. No serious complications happened. Patients starting the IPLT during the expansion period required less treatment times of depilation (p < 0.05). ConclusionAuricular reconstruction using a single expanded scalp flap combined with intense pulse light depilation is a safe, effective and less invasive technique for hemifacial microsomia with extremely low hairline, and providing highly satisfying results. Initialing the IPLD during the expansion period is recommended. Clinical question/level of evidenceTherapeutic, IV.

Application of controllable hair density of eyebrow reconstruction with the treatment of scar baldness during the same operation stage

Objective To explore a method of eyebrow reconstruction which can control eyebrows, and to repair scar baldness in the same operation stage. Methods Operations were performed in two stages. In the first stage, an expander was placed under the scalp at the same side of the defect eyebrow through the direction of the superficial temporal artery. Other expanders were placed around the scar baldness. After the incision healed, water was injected into the expander. During the expansion, the scalp hair density was approaching the uninjured eyebrow side. Then the second stage operation was prepared: an island flap with superficial temporal artery as axial artery was harvested and the expander was extracted. The subcutaneous tunnel was made in the temporal region of the eyebrow defect side. The expanded superficial temporal artery island scalp flap was passed through the tunnel and transferred to the defect eyebrow area to repair the eyebrow. After incising the scar baldness, the left expanded scalp flaps were transferred to cover the wound. Results 12 patients underwent this method of eyebrow reconstruction with scar baldness, all island scalp flaps survived, with no case of flap necrosis. After 6-24 months of follow-up, the hair density of the reconstructed eyebrows was very close to that of the uninjured side, without excessive thickening or excessive rarefaction. The scalp scars were small and can be shaded by the hair. All patients were satisfied with the operation. Conclusions The method of controllable hair density of eyebrow reconstruction with the treatment of scar baldness has good effects on reconstructing eyebrow defect and scar baldness. It is simple, economic and suitable for further application. Key words: Eyebrows; Cicatricial alopecia; Surgical operation; Eyebrow reconstruction

Forehead reconstruction with a custom-made three-dimensional titanium implant in a Parry-Romberg syndrome patient.

Parry-Romberg syndrome is a rare neurocutaneous syndrome characterized by progressive shrinkage and degeneration of the tissues usually on only one side of the face. It is usually difficult to restore the facial contour due to skin tightness. In this case report, we report a forehead reconstruction with custom-made three-dimensional (3D) titanium implant of a Parry-Romberg syndrome patient who was treated with multiple fat grafts but had limited effect. A 36-year-old man presented with hemifacial atrophy. The disease progressed from 5 to 16 years old. The patient had alopecia on frontal scalp and received a surgery using tissue expander. The alopecia lesion was covered by expanded scalp flap done 22 years ago. Also, he was treated with fat grafts on depressed forehead 17 years ago. However, it did not work sufficiently, and there was noted depressed forehead. We planned to make 3D titanium implant to cover the depressed area (from the superior orbital rim to the vertex). During the operation, we confirmed that the custom-made 3D implant accurately fit for the depressed area without any dead spaces. Previously depressed forehead and glabella were elevated, and the forehead contour was improved cosmetically. A custom-made 3D titanium implant is widely used for skull reconstruction and bring good results. In our case, the depressed forehead of a Parry-Romberg syndrome patient was improved by a 3D titanium implant.

The Combination of Expanded Scalp Flap and 800 nm Diode Laser in the Reconstruction of Forehead Defect

Skin grafting is often the first choice for closing forehead defects. However, the aesthetics of skin grafting-reconstructed forehead defects are still not accepted by a large number of patients. With the technological advancement of laser hair removal, scalp flaps have been considered as donors for reconstruction of forehead defects. We evaluated 10 cases of forehead defect reconstructions with expanded scalp flaps followed by hair removal by an 800nm diode laser. All flaps survived uneventfully and underwent 4-6 laser treatments for hair removal. The appearances of the reconstructed foreheads were similar to that of the adjacent skin, and all patients were satisfied with the treatment outcomes during the 6-24months of follow-up. It is concluded that the combined treatments of expanded scalp flaps and diode laser hair removal are effective for repairing forehead defects.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical efficacy of expanded scalp flap combined with laser hair removal on frontal lesions

Objective To explore the clinical results of repairing frontal lesions with the combination of the expanded scalp flaps and postoperative laser hair removal. Methods There were 10 patients involved between May 2014 through May 2016 in our department. In the first stage, the expanders were implanted to the pockets under the scalp. In the second stage, the wounds, after lesion removal, were covered by the expanded scalp flaps. In the third stage, laser hair removal was performed 2 weeks postoperatively for 4 to 6 times until complete removing the hair. Results All the lesions were repaired with good results. The incisions healed primarily. The scalp flaps survived without necrosis. The hair on the flap was removed completely. The color and texture of the flap were similar to these of the adjacent skin. The satisfactory results of the appearance were achieved in all the patients. Conclusions The combination of the expanded scalp flap and laser hair removal is an effective method for the repairing of the frontal lesion. Key words: Tissue expansion; Scalp flap; Frontal lesion

Clinical efficacy of expansion of scalp flap and hair transplantation for hair loss at the temples

Objective To explore the effects of the expansion of scalp flap and hair transplantation on hair loss at the temples. Methods Clinical data of patients with hair loss at the temples who were treated with hair transplantation (n=69) and tissue expansion (n=48) between Aug. 2004 and July 2013 were retrospectively analyzed. The hair grafting technique was carried out by harvesting a scalp strip from the back of head, then dividing it into a series of 1-3 hair grafts and finally implanting them into the prepared recipient holes of lesion with a desired hair direction. Tissue expansion was performed by firstly positioning a tissue expander in the subgaleal pocket of scalp and subsequently inflating it with normal saline. Therefore, an expanded scalp flap was designed, with the combination of advancement and rotation flap transplantation principles, to be transferred to the recipient site after lesion removal. Results Over 8-month to 3-year of follow-up, the hair transplanted grew well. The direction was satisfied. The folliculitis was found in seven burn patients and cured after embrocating 75% alcohol. Fifteen patients experienced encryption transplantation for feeling a sparse hair. Forty-eight patients with tissue expansion achieved very satisfactory results. Hair transplantation with intact follicle was conducted in 6 patients for smaller coverage area and worse appearance. Eleven patients dissatisfied with the direction of hair growth. The hematoma was found in 2 patients but did not impact on treatment effects. Conclusions Hair transplantation may be applied in the treatment of simple hair loss at the temples. Therefore, the tissue expansion could be an optimal choice for hair loss at the temples combined with adjacent scale defect and unstable scar. Key words: Expand flap; Transplantation; Temple

Reconstruction avec prothèse d’expansion d’une alopécie secondaire à une brûlure du cuir chevelu par Taser®

Scarring alopecia resulting from burns may be difficult to treat and involves various plastic surgery techniques such as expanded scalp flaps. Herein, we report the case of a 19-year-old male patient who suffered burning of the scalp with scarring alopecia following an attack with a Taser(®) electrical gun. Given the extent and site of alopecia, we decided to create a prosthesis by means of scalp expansion. The cosmetic result was satisfactory. Several scalp reconstruction techniques have been described for scarring alopecia, with the most widely used being expansion, scalp flaps, repeated excision and hair implants. The present case suggests that scalp expansion offers an effective method for the reconstruction of scarring alopecia following burns with a Taser(®) device.

Treating Cutis Verticis Gyrata Using Skin Expansion Method

The objective of this study was to evaluate the feasibility and clinical effect of repairing scalp defect after the excision of cutis verticis gyrata using expanded scalp skin flaps. For this purpose, 8 patients with cutis verticis gyrata were subjected to scalp skin expander implantation under the skin. After saline injection and scalp expansion for 2-3months, the cutis verticis gyrata was excised and the expanded scalp flaps were applied to recover the skin defect. As a result, the flaps and hair grew well without contractures and significant scarring, suggesting that this method is useful for surgical correction of cutis verticis gyrata.

Plastic surgical management of large cicatricial scalp alopecia

To investigate the proper ways to manage a large cicatricial scalp alopecia. Based on the location, size and condition of the scarring lesions, 218 patients with 20 - 75% scarring alopecia were selected and treated with either dense-packing hair grafting technique (136 cases) or tissue expansion (82 cases). There were 209 in burn, 5 in avulsed injury and 4 in tumor excision. The lesions with thick, stable scars in the frontal or/and temporal areas undergoing either hair grafting or tissue expansion process as desired by the patients. In addition, the alopecia in an unstable scar on the skull, with skull defect under the lesion and the lesion involved in the back of the head was only treated with tissue expansion. The hair-grafting technique was carried out by harvesting a scalp strip from the back of the head, then dividing it into a series of 1 - 3 hair grafts and finally implanting them into the prepared recipient holes of the lesion with a desired hair direction. Ten areas with 1 cm(2) size in 10 patients were randomly selected to examine the hair survival over 8 months post-operation. Tissue expansion was performed by firstly positioning a tissue expander in the subgaleal pocket of the scalp and serially inflating it with normal saline in 5 - 7 days intervals for about 3 months. Thereafter, an expanded scalp flap was designed, with the combination of advancement and rotation flap transplantation principles, to be transferred to the recipient site after lesion removal. In patients with hair-grafting technique, hair density reaching 60 - 80 hairs/cm(2) per session. Over 8-months following-up, the grafted hairs grew good with 98% hair survival. Forty-five patients with 20% - 30% scalp hair loss were reaching very satisfactory results with only one session while 91 patients with 31% - 50% hair loss were needed a second session to improve their appearance. In those with tissue expansion, 56 patients with 20% - 50% scalp loss were managed in one session and 26 patients with 51% - 75% scalp loss needed secondary tissue expansion. All of the expanded hair-bearing flaps survived well with only minimal complications (9.8%) of the infective dome explosion in 3, slight skull depression in 2, seroma in 5 and early infection in 1. Either hair grafting or tissue expansion is proven as a safe and effective technique for restoration of large cicatricial scalp alopecia. The former technique could be of benefits to simple, mini-surgical procedure, natural hair growth and good for lesion size under 30%. And the letter technique shows wider clinical indications, especially for the patients with unstable scar, skull defect under lesion and lesion over 50%. But the obvious drawbacks are multi-clinic visiting, disfigurement and long-term procedures.

The Expanded “Flying-Wings” Scalp Flap for Aesthetic Hemiscalp Alopecia Reconstruction in Children

For a large lesion of the scalp (e.g., up to 50% scalp loss), restoration of the scalp with a hair-bearing scalp flap to achieve a pleasing aesthetic outcome and hair growth matched to the direction of the lesion, especially for a hemiscalp defect in children, often becomes very difficult and challenging for plastic surgeons. Treatment was performed for 18 children with severe hemiscalp losses after burns. The technique was carried out by initially positioning a tissue expander in the subgaleal pocket of the scalp and serially inflating it with normal saline in 5- to 7-day intervals for about 3 months. Thereafter, a "flying-wings" expanded scalp flap was designed by combining advancement and rotation flap transplantation principles. This design was based on at least one nominated vascular system of the scalp used as the pedicle, with the wings often working to correct the distant part of the lesion in which the hair direction is greatly changed. After the lesion was excised, the expanded hair-bearing flap was advanced and rotated to the recipient site when the expander was removed. For the 18 patients, the flap used for hemiscalp reconstruction could be transferred to repair the hemiscalp loss totally (for 17 patients) or mostly (for 1 patient) in a single-tissue expansion process without flap necrosis. The patient with a remaining lesion was treated completely with a secondary tissue expansion in the postauricular area. All the patients showed good aesthetic results, with the hair growth direction matching the recipient site well. The described technique strongly indicates that tissue expansion is a simple, safe, and efficient technique for large scalp restoration. The "flying-wings" design of the expanded scalp flap can properly distribute the expanded hair-bearing scalp in the recipient site.

Application of tissue expansion in repair of scalp avulsion with skull exposure

目的 寻求头皮撕脱回植失败并颅骨裸露较理想的早期修复的方法.方法伤区清创植皮、颅骨裸露区油纱外敷,植皮成活后尽早于创周正常头皮下置入扩张器,注水扩张完成后利用扩张皮瓣修复秃发颅骨裸露区.结果6例除1例出现局部扩张器外露外,均未发生感染、皮瓣坏死等并发症,同时达到创面修复及秃发区重现头发的目的.结论在适当选择适应证及正规操作的前提下,将组织扩张术用于头皮撕脱回植失败并颅骨裸露的早期修复可以取得满意的疗效。