Hair-bearing Scalp Research Articles

One-Stage Sideburn Reconstruction With Hair-Bearing Scalp Based on the Retroauricular Branch of the Superficial Temporal Vessels

One-Stage Sideburn Reconstruction With Hair-Bearing Scalp Based on the Retroauricular Branch of the Superficial Temporal Vessels

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.

Ruby Laser Irradiation (694 nm) of Human Skin Biopsies: Assessment by Electron Spin Resonance Spectroscopy of Free Radical Production and Oxidative Stress during Laser Depilation

Human skin biopsies (hair-bearing scalp skin and non-hair-bearing breast skin) were treated with t-butylhydroperoxide, irradiated with UV light (UVR) or irradiated with 694 nm ruby laser red light. Free-radical production and oxidative stress were assessed with electron spin resonance spectroscopy (ESR) using the ascorbate radical as a marker. In comparison with both UVR and t-butyl-hydroperoxide (which readily induce the ascorbate radical in hair-bearing and hairless skin), 694 nm red light does not result in the formation of the ascorbate radical in detectable concentrations. Spin-trapping experiments with the spin trap 5,5-dimethyl-1-pyrroline N-oxide (DMPO) showed that while free radicals could be detected after treatment of skin with t-butylhydroperoxide, radicals could not be trapped after laser treatment. Treatment of lasered skin (containing DMPO) with t-butylhydroperoxide produced radical adducts as well as the ascorbate radical, demonstrating that the laser neither depletes endogenous ascorbate nor the preadministered spin trap. It is concluded that 694 nm red light does not induce oxidative stress in human skin in levels comparable either to t-butyl hydroperoxide or UV light.

Microtia repair: Creation of a functional postauricular sulcus

Objective: Auricular reconstruction for repair of severe congenital microtia can provide the patient with a realistic-looking pinna. However, an unseen functional cephaloauricular sulcus is necessary, especially for patients with eyeglasses. Technique: (1) A skin graft is harvested. (2) The ear framework is separated substantially from the side of the head. (3) A crescent of hair-bearing scalp skin is excised. (4) The donor skin graft is divided. One part of the graft surfaces the superolateral and medial portions of the auricular framework into the sulcus depth; the remainder covers the side of the head. Results: This simple technique was effective. Minor transient sequelae have included granulation tissue (2 patients), localized infection (2 patients), and adhesion (1 patient). Patients requiring glasses have worn frames soon after surgery, and no sulcus problems have resulted. Conclusion: Creation of this postauricular sulcus during microtia reconstruction is easily performed and offers the patient a durable and functional space, especially for eyeglass wear. (Otolaryngol Head Neck Surg 1999;120:789-93.)

Another indication for liposuction: small facial lipomas.

The treatment of facial lipomas at times requires the use of incisions that are less than satisfactory in either size or location. In an effort to minimize scarring, the authors have been removing these lesions with liposuction. The purpose of this study was to review the authors' experience in treating small facial lipomas using liposuction. Over the last 10 years, the authors treated five patients with forehead lipomas by removal with liposuction through hair-bearing scalp incisions. All patients were evaluated after the procedure for bleeding, paresthesias, recurrence, scarring, and overall satisfaction with the procedure. All of these patients had lipomas that measured 4 cm or less at the time of surgery. No patient experienced hematoma, nerve injury, or recurrence. All patients were completely satisfied with their result and scar. The literature describes an advantage to using liposuction for the treatment of medium (4 to 10 cm) and large (>10 cm) lipomas. Because small lipomas (<4 cm) can be extracted through small incisions, the literature reports no advantage to removal with liposuction. However, favorable aesthetic results can be obtained by removing small facial lipomas with liposuction through strategically placed incisions.

Ruby Laser Irradiation (694 nm) of Human Skin Biopsies: Assessment by Electron Spin Resonance Spectroscopy of Free Radical Production and Oxidative Stress during Laser Depilation

Abstract Human skin biopsies (hair-bearing scalp skin and non-hair-bearing breast skin) were treated with t-butylhydro-peroxide, irradiated with UV light (UVR) or irradiated with 694 nm ruby laser red light. Free-radical production and oxidative stress were assessed with electron spin resonance spectroscopy (ESR) using the ascorbate radical as a marker. In comparison with both UVR and t-butyl-hydroperoxide (which readily induce the ascorbate radical in hair-bearing and hairless skin), 694 nm red light does not result in the formation of the ascorbate radical in detectable concentrations. Spin-trapping experiments with the spin trap 5,5-dimethyl-l-pyrroline N-oxide (DMPO) showed that while free radicals could be detected after treatment of skin with t-butylhydroperoxide, radicals could not be trapped after laser treatment. Treatment of lasered skin (containing DMPO) with t-bu-tylhydroperoxide produced radical adducts as well as the ascorbate radical, demonstrating that the laser neither depletes endogenous ascorbate nor the preadministered spin trap. It is concluded that 694 nm red light does not induce oxidative stress in human skin in levels comparable either to t-butyl hydroperoxide or UV light.

Hair Tie-Over Dressing

To describe a temporary dressing for Mohs micrographic surgery wounds of the hair-bearing scalp. The technique of using hair at the wound edges to hold down the dressing is described. This is an effective, simple, comfortable, and inexpensive scalp dressing, which our patients have found to be very acceptable. We consider that the hair tie-over dressing is an ideal temporary dressing for Mohs micrographic surgery wounds of the hair-bearing scalp.

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.

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.

Composite tempororetroauricular flap for the reconstruction of the lower lid and eye socket in the elderly

In this paper, experience with the composite tempororetroauricular flap (TRF) in three elderly patients undergoing lid reconstruction and one elderly patient undergoing socket reconstruction are presented. The composite TRF allows three layered cover in orbital reconstruction. The secondary defect and scarring of the donor site is concealed behind the ear and in the hair-bearing scalp. The procedure is completed in a single stage.

Tissue expansion in neurosurgical reconstructive technique: case report

BACKGROUND Various reconstructive techniques using hair-bearing scalp to manage unsightly scalp defects have been described in 1983 Fonseca and in 1984. Horowits emphasized the use of galeal-pericranial flaps in scalp wounds with exposed bone in 1986. Matthews and Missoten described early tissue expansion to close a traumatic defect of the scalp, and in 1990 Kiyono placed tissue expander in a pocket adjacent to the defect that was covered with Martex Mesh. METHODS The authors present a case of 23-year-old man with a scalp lacetation over a depressed fracture of the skull and a dural tear, after a traffic accident. The repair procedures at another hospital failed, resulting in an area of scalp necrosis with a cerebrospinal fluid (CSF) leak. At our observation, the reconstructive technique using hair-bearing scalp with tissue expander was performed to managed unsightly scalp necrosis. Moreover the neurosurgical treatment was necessary to avoid the complications of the CSF leak. CONCLUSIONS A 9-year review showed more than 40 patients treated by this technique that allows a pericranial flap of every size. When scalp defects are too large, the tissue expander allows good aesthetic results.

Delineating the “Safe” Donor Area for Hair Transplanting

Three hundred twenty-eight patients were examined and classified according to age (65–69, 70–74, 75–79, and ≥80 years) and degree of male pattern baldness Hamilton/Norwood Class I-VII. In addition, the inferior to superior height of potential temporal, parietal, and occipital donor sites containing at least eight hairs per 4-mm round circle was measured. A schematic drawing of the borders of this “safe” donor area containing permanently hair-bearing scalp with adequate hair density for transplanting is presented.

Scalp Extension

Surgery to correct extensive alopecia requires increasing the surface of hair-bearing scalp and removing bald scalp. Two commonly used methods, scalp expansion and scalp reduction, have disadvantages. To describe a new method, scalp extension, that employs a thin sheet of bioplastic (an extender) stretched and attached with hooks to the galea after scalp reduction. The surgical technique is described and the results compared with those of patients who have undergone scalp reduction and scalp expansion. A study of the first fifteen cases treated is presented. During the few weeks that the extender is implanted, the constant tension it exerts on the galea causes a progressive stretching of the scalp. Data from the first fifteen cases treated reveal eradication of more extensive bald areas than with scalp reduction, making it possible to cut the number of operations necessary in half while considerably shortening total treatment time. The absence of major side effects, along with the absence of any deformation of the scalp (unlike scalp expansion), explains the excellent acceptability of the instrument by patients. Scalp extension appears to be a useful adjunctive technique in hair replacement and reconstructive surgery, and has distinct advantages over standard scalp reduction and tissue expansion techniques.

Variations on the temporoparietal fascial flap

An improved understanding of the vascular supply of the layers of the temporal fossa has increased the potential of this region for new and ingenious reconstructive techniques. Separate and independently vascularized layers of this region include hair-bearing scalp, glabrous skin, tempororoparietal fascia (and galea aponeurotica), temporalis muscle and fascia, and pericranium. Island flaps of glabrous skin and scalp provided esthetically appropriate tissue to cover a variety of defects. The malleable bulk of the subcutaneous fascial layers were combined with skin grafts to restore thin lining, and used as a vascularized bed for cartilage grafts in otherwise unsatisfactory recipient sites. Illustrative cases from our 5-year clinical experience are presented to demonstrate various combinations of the temporoparietal fascial pedicle with tissues from the temporal region to reconstruct the eyebrows, eyelids, orbits, cheeks, and lips.

Treatment of burn alopecia with tissue expanders in children.

During the past 18 months, 60 tissue expanders were utilized in the reconstruction of 42 children with burn alopecia of the scalp not amenable to a single excision and primary closure at the Shriners Burns Institute in Galveston, Texas. The children were grouped according to the degree of alopecia. All patients with defects of 15 percent or less of the total hair-bearing scalp were able to obtain complete closure of their defects with two operations, i.e., one to place the expander and the second to remove the expander and advance the flaps. Some patients with defects up to 40 percent were closed with serial expansion. Patients with even larger defects had a significant reduction in the percentage of alopecia and benefited from re-creation of anterior hairlines. We have encountered a postoperative complication rate of 10 percent. When compared to previous methods of treating burn alopecia, tissue expansion allows a more rapid closure, fewer operations and coincident anesthetics, and decreased total length of hospitalization.

Early tissue expansion to close a traumatic defect of scalp and pericranium

A case is presented in which an extensive area of traumatically denuded skull bone was successfully closed using a tissue expanded, hair-bearing scalp rotation flap, following expander insertion on the third day after injury. No split skin grafting was required and, in view of the high quality of cosmesis achieved, it is recommended that the technique be considered for other cases of acute traumatic soft tissue loss.

A free occipital hair-bearing flap for reconstruction of the upper lip

A free hair-bearing occipital scalp flap was employed for reconstruction of the upper lip in a young man who had sustained a close range shotgun blast to the face. The “moustache” free-flap provides an abundant source of hair-bearing scalp which has certain advantages over conventional techniques of repair. It is a one-stage operation, involves minimal donor site morbidity and uses hair-bearing scalp which is not usually affected by male-pattern baldness.

Split-thickness scalp flap for resurfacing full thickness forehead and temporal scalp defects

Summary A technique is described for the resurfacing of large full-thickness defects of the forehead and temporal area. A hair-bearing scalp flap is rotated to achieve cover. This is later split at a deep dermal plane, preserving the hair follicles, and is returned to its original site. The soft tissue remaining on the site of the original wound is surfaced with a split-thickness skin graft. Three cases illustrating the technique are presented.

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.

Replacement of scar with hair-bearing scalp.

A PERSON with areas of absent hair attracts attention and is likely to become self-conscious and most anxious to have the deformity improved or, if possible, eliminated. If the area of absent hair ...