Expanded Scalp Flap Research Articles

RADIOLOGICAL QUIZ

This report presents an apparent squamous cell carcinoma over a burn scar in the scalp (Marjolin's ulcer) that was resected and soft tissue expanders inserted in the hair-bearing scalp. In the postoperative period the patient developed neurological impairment with a CT scan showing a parasagittal brain tumour infiltrating the skin. The tumour was resected and the resultant skin and cranial defect were covered with an expanded scalp flap. Histological examination showed a malignant angioblastic meningioma. The tumour recurred aggressively, leading to the death of the patient. The case is considered very unusual, as a brain tumour does not seem to be a reasonable suspect in the differential diagnosis of a chronic ulcer over a burn-induced scalp scar.

Ineffectiveness of Acute Scalp Expansion

The aim of this study was to test the ex vivo biomechanical properties of acutely expanded scalp flaps to quantitatively assess the efficacy of acute scalp expansion. A total of 14 fresh male cadavers were used for the study. In each cadaver, a rectangular (4 x 10 cm), laterally based flap was designed on each side of the scalp, starting from the superior margin of the external auditory canal. One randomly selected flap per scalp underwent acute intermittent expansion (a 3-minute expansion/3-minute rest cycle was performed three times with the maximum expansion achievable); the contralateral flap served as a control. After the expansion process, the acutely expanded flaps were measured to assess whether applied biomechanical stress caused any changes in flap dimensions. The biomechanical properties (stress/strain ratio, mean stiffness) of both expanded and control flaps were then assessed by means of a dynamometer and a force transducer. The obtained data showed that the biomechanical benefits provided by acute scalp expansion were not statistically different (p < 0.05) from those obtained by simple subgaleal undermining. No change of length nor gain in compliance was observed in the acutely expanded flaps as compared with control scalp flaps. In the authors' opinion, a possible explanation (to be further validated) for the lack of effect of acute scalp expansion might be that the inelastic galea aponeurotica did not allow mechanical creep to exploit the inherent elastic properties of the overlying scalp skin.

Aesthetic reconstruction of burn alopecia by using expanded hair-bearing scalp flaps.

Tissue expansion is one of the most important armamentaria for aesthetic scalp reconstruction after burn; however, the proper way to employ this technique for the scalp reconstruction usually presents a challenge to the plastic surgeon, especially in the case of a "sideburn" scenario or a large lesion, as with, for example, hemiscalp alopecia. In this article, 11 patients, with different degrees of hair-bearing scalp loss as a result of burn, and including four patients with hemiscalp alopecia were successfully treated by using tissue expansion. The results show that tissue expansion is a simple, safe, and efficient technique for aesthetic scalp reconstruction. Versatile design of the expanded scalp flap can distribute the expanded hair-bearing scalp properly in the reconstructed recipient site.

Free expanded scalp flap for reconstruction of the temporal hair line

A 20-year-old male who sustained a severe avulsion injury of his left scalp and face together with a cranial bone fracture on his right temple six years previously, presented with extensive alopecia over the left temporal scalp. There was also a depression in the right temple with complex scarring caused by previous operations. A simultaneous complete reconstruction of the scalp defect and the depression was obtained by expansion of the left temporoparietal scalp, followed by free-flap transfer of the expanded tissue and augmentation with a free scapular flap. The end result was very satisfactory.

Primary intracranial malignant tumour mistaken for a postburn scalp Marjolin's ulcer

This report presents an apparent squamous cell carcinoma over a burn scar in the scalp (Marjolin's ulcer) that was resected and soft tissue expanders inserted in the hair-bearing scalp. In the postoperative period the patient developed neurological impairment with a CT scan showing a parasagittal brain tumour infiltrating the skin. The tumour was resected and the resultant skin and cranial defect were covered with an expanded scalp flap. Histological examination showed a malignant angioblastic meningioma. The tumour recurred aggressively, leading to the death of the patient. The case is considered very unusual, as a brain tumour does not seem to be a reasonable suspect in the differential diagnosis of a chronic ulcer over a burn-induced scalp scar.

Cross transposition of expanded scalp flaps for treatment of postburn cicatricial alopecia. (Chinese) Chin

Cross transposition of expanded scalp flaps for treatment of postburn cicatricial alopecia. (Chinese) Chin

Expanded Bilateral Advancement Transposition (BAT) and Triple Advancement Transposition (TAT) Flaps for Treatment of Male Pattern Baldness

The purpose of this paper is to present and describe the Anderson Expanded Bilateral Advancement Transposition (BAT) Flap and Triple Advancement Transposition (TAT) Flap techniques for elimination of moderate and extensive degrees of male pattern baldness. The advantages, disadvantages, and results will also be presented. At the present time, despite claims of success with various medical treatments, there is no nonsurgical method that will predictably reverse balding or stimulate the growth of new hair. The best results for the treatment of male pattern baldness and the popularity and predictability of hair replacement surgical techniques have advanced dramatically in recent years. Scalp expansion definitely ranks as one of the most significant advances in surgical hair replacement in the last century. The goal of all our hair replacement surgery techniques is the most efficient and effective use of the remaining hair follicles to cover the bald or balding area. Expanded scalp flaps accomplish this goal in an effective and efficient manner.

Repair of Scalp Defects Using a Tissue Expander and Marlex Mesh

A simple technique using Marlex mesh and a tissue expander to cover scalp defects is described and two patients are presented. This technique is suitable for medium-sized defects that cannot be closed primarily. Marlex mesh is sutured to the wound edges in lieu of a temporary skin graft and to prevent enlargement of the defect during tissue expansion. The tissue expander is placed under adjacent normal scalp in a subgaleal pocket developed through the scalp defect. The scalp defect is closed secondarily using the expanded scalp flap. This technique was performed in two patients with satisfactory results. Marlex mesh obviates the need for a temporary skin graft to cover the scalp defect.

Salvage of an Avulsed Expanded Scalp Flap to Correct Burn Alopecia

The use of tissue expanders in reconstructive surgery has become well established, but their use has been associated with multiple complications. Salvage of expanded tissue after traumatic extrusion of the prosthesis has not been previously reported. We have outlined the principles involved in the management of such a case, and reviewed previously reported complications of tissue expansion.

Reconstruction of post burn scalp alopecia by using expanded hair-bearing scalp flaps.

Background and Objective:Tissue expansion is a time-tested and frequently used procedure for utilizing local tissue to replace large defects. We aimed to assess the success & complications of tissue expansion in correction of post burn scalp alopecia.Methods:In this study, 30 patients of scalp burn alopecia of 5 to 35 years age group were treated with tissue expansion of the scalp at Bahawal-Victoria Hospital from January 2013 to December 2014. The area of the scalp loss was within 1/5 to 2/5. Our technique employed an insertion site distal to the area needed to be expanded, attempting to minimize complication like extrusion & wound dehiscence. The patients were followed-up weekly during first month and then fortnightly for next four months.Result:Our study involved 8 male (26.67%) and 22 female subjects (73.33%) with a mean age of 21years. Flame burn accounted for the mostly 53.3% (n=16) of scalp burns & parieto-temporal region was most commonly affected in 33.4% (n=10) of subjects. Desired aesthetic results were achieved in all the patients without any major complication. Minor complication included mild infection in 8 (26.67%), seroma in 4 (13.33%) & wound dehiscence in 2 (6.67%) patients.Conclusion:Tissue expansion is a simple, safe, & efficient technique for aesthetic scalp reconstruction. With a simple modification of distal incision and tunneling, we succeeded in minimizing complications. Versatile design of the expanded scalp flap can distribute the expanded hair-bearing scalp properly in the reconstructed recipient site.