Scalp Burn Research Articles

Low intensity focused ultrasound stimulation in stroke: A phase I safety & feasibility trial.

We aimed to determine the maximum safe spatial-peak pulse-average intensity (ISPPA) of low-intensity focused ultrasound stimulation (LIFUS) in stroke patients and explore its effect on motor learning and corticospinal excitability. We adopted the classic 3+3 design to escalate ISPPA (estimated in-vivo transcranial value) from 0, 1, 2, 4, 6, to 8W/cm2. Stopping rules were pre-defined: 2nd-degree scalp burn, clinical seizure, new lesion on diffusion-weighted imaging or major reduction in apparent diffusion coefficient, and participant discontinuation due to any reason. We applied 12-min LIFUS over the ipsilesional motor cortex while participants were concurrently practicing 3 blocks of a motor sequence learning (MSL) task using the affected hand. We measured MSL (response time) and corticospinal excitability (motor evoked potential) pre- and post-stimulation and compared MSL and corticospinal excitability between the LOW (0, 1, and 2W/cm2) and HIGH (4, 6, and 8W/cm2) groups. ISPPA was escalated to 8W/cm2 with 18 stroke participants without meeting the stopping rules. Compared to the LOW, more participants in the HIGH performed better on MSL (6/9 vs. 0/9, p=0.009) and showed a sign of greater corticospinal excitability (7/9 vs. 5/9, p=0.62). Our phase-I safety study suggests that one session of LIFUS up to 8W/cm2 ISPPA is safe and feasible in stroke patients, and LIFUS at high intensity induces positive changes in both MSL and corticospinal excitability. The next logical step is to conduct a phase-II trial testing the efficacy of LIFUS and continuously monitoring its safety profiles.

Chemical Scalp Burn after Hair Coloring-Case Report with Literature Review.

Hair dyeing is widely performed around the world. Chemical and thermal burns can result from the components present in brightening and coloring products, as well as the application process. We present a case of a chemical burn after applying hair dye and review the literature on similar cases, the composition of hair dyes, their mechanism of action, and the process of burns. The patient was a 17-year-old girl, who presented to the Dermatology Clinic with a 13 × 10 cm ulcer on the scalp after hair dyeing in a hairdressing salon. General and local treatment was applied, with particular emphasis on specialized dressings. The ulcer site was replaced by an area of scarring after 11 months of treatment. Based on the presented case and the review of the literature, we conclude that hair dye treatments warrant careful attention for potential scalp complications. The diagnostic and therapeutic approach demands a multidisciplinary effort, with ongoing patient-doctor cooperation throughout the treatment, which may complicate and span several months.

Multidisciplinary approach for a severe head burn caused by high-voltage electrical shock - a case report

In modern reconstructive medicine, personalized bone substitutes provide therapeutic hope for patients with non-standard bone defects. The study aims to present a description of a case of using a personalized bone substitute material, taking into account the vascular connections formed after a previous skin transplant. 
 The 29-year-old patient was admitted to the plastic surgery department urgently after being electrocuted with high voltage. Due to extensive scalp burns, a skin graft was performed in the area of previously removed skin along with a charred skull bone vault. 
 After a few months, the patient was qualified for cranioplasty with the use of personalized bone substitutes. The necessity to make cuts around the vascular connections present in the transplanted tissue was the main difficulty in the for the operator. 
 The operation was successful and the recovery was uneventful. The patient was discharged home in good general and local condition. 
 The presented case illustrates the need to take into account creating vascular connections with the use of personalized bone substitutes in patients after skin transplants.

Transcranial Direct Current Stimulation vs Sham for the Treatment of Inattention in Adults With Attention-Deficit/Hyperactivity Disorder

Transcranial direct current stimulation (tDCS) may improve symptoms of inattention in adults with attention-deficit/hyperactivity disorder (ADHD). However, previous trials are characterized by small sample sizes, heterogeneous methodologies, and short treatment periods using clinic-based tDCS. To determine the efficacy and safety of home-based tDCS in treating inattention symptoms in adult patients with ADHD. Randomized, double-blind, parallel, sham-controlled clinical trial (tDCS for the Treatment of Inattention Symptoms in Adult Patients With ADHD [TUNED]), conducted from July 2019 through July 2021 in a single-center outpatient academic setting. Of 277 potential participants screened by phone, 150 were assessed for eligibility on site, and 64 were included. Participants were adults with ADHD, inattentive or combined subtype. Exclusion criteria included current stimulant drug treatment, current moderate to severe symptoms of depression or anxiety, diagnosis of bipolar disorder with a manic or depressive episode in the last year, diagnosis of schizophrenia or another psychotic disorder, and diagnosis of autism spectrum disorder; 55 of participants completed follow-up after 4 weeks. Thirty-minute daily sessions of home-based tDCS for 4 weeks, 2 mA anodal-right and cathodal-left prefrontal stimulation with 35-cm2 carbon electrodes. Inattentive scores in the clinician-administered version of the Adult ADHD Self-report Scale version 1.1 (CASRS-I). Included in this trial were 64 participants with ADHD (31 [48%] inattentive presentation and 33 [52%] combined presentation), with a mean (SD) age of 38.3 (9.6) years. Thirty participants (47%) were women and 34 (53%) were men. Fifty-five finished the trial. At week 4, the mean (SD) inattention score, as measured with CASRS-I, was 18.88 (5.79) in the active tDCS group and 23.63 (3.97) in the sham tDCS group. Linear mixed-effects models revealed a statistically significant treatment by time interaction for CASRS-I (βinteraction = -3.18; 95% CI, -4.60 to -1.75; P < .001), showing decreased symptoms of inattention in the active tDCS group over the 3 assessments compared to the sham tDCS group. Mild adverse events were more frequent in the active tDCS group, particularly skin redness, headache, and scalp burn. In this randomized clinical trial, daily treatment with a home-based tDCS device over 4 weeks improved attention in adult patients with ADHD who were not taking stimulant medication. Home-based tDCS could be a nonpharmacological alternative for patients with ADHD. ClinicalTrials.gov Identifier: NCT04003740.

Effects of clinical application of free anterolateral thigh perforator lobulated flap in repair of electrical burn wounds on head based on the concept of donor site protection

Objective: To explore the effects of clinical application of free anterolateral thigh perforator lobulated flap in repair of electrical burn wounds on head based on the concept of donor site protection. Methods: A retrospective observational study was conducted. Eight patients with electrical burns with huge scalp defects and exposed skulls were admitted to the First Affiliated Hospital of Zhengzhou University, from May 2017 to December 2019, who were all males, aged 21-57 (39±13) years, sustaining multiple deep partial thickness to full-thickness electrical burns to 5%-14% total body surface area. Among the scalp burn sites of the patients, 1 case was posterior occipital, 2 cases were parietal occipital, 4 cases were parietal temporal, and 1 case was frontotemporal. After debridement, the defect area was 10 cm×9 cm-16 cm×14 cm. The incision area of the free anterolateral thigh perforator lobulated flap was 22 cm×6 cm-30 cm×9 cm. The artery and vein of flap were anastomosed with superficial temporal artery and vein or facial artery and vein, and the other vein of skin flap was anastomosed with superficial vein of recipient area. The donor site of skin flap was closed by layer interrupted tension-reducing suture. After the operation, the survival of flop, donor site wound healing and complications were observed. The flap appearance, wound healing of donor sites, long-term complications and functional recovery of donor sites were observed on follow-up. Results: After the operation, the flaps of 8 patients survived completely without vascular crisis. The donor sites of flaps in all the patients healed well with no osteofascial compartment syndrome. Seven patients were followed up for 3 to 12 months, and 1 case was lost to follow up. During follow-up, the flaps of the patients' heads were in good appearance but with alopecia. The donor sites showed linear scars, which were well hidden. There were no significant differences in sensory and motor functions between the two sides, and no complications were found such as muscle hernia. Conclusions: Free anterolateral thigh perforator lobulated flap has a good clinical effect in the early repair of electrical burn wounds with huge scalp defect and skull exposure on head, and the donor wounds can be directly closed and sutured, greatly reducing the damage to the donor area.

Relation of circulating estrogens with hair relaxer and skin lightener use among postmenopausal women in Ghana.

Hair relaxers and skin lighteners have been commonly used by African women, with suggestions that they may have hormonal activity. To investigate the relationship of hair relaxer and skin lightener use to serum estrogen/estrogen metabolite levels. We utilized the postmenopausal population-based controls of the Ghana Breast Health Study to estimate adjusted geometric means (GM) and 95% confidence intervals of individual circulating estrogen levels by hair relaxer/skin lightener exposure categories. Of the 585 postmenopausal women included in our analysis, 80.2% reported hair relaxer use and 29.4% skin lightener use. Ever hair relaxer use was positively associated with estriol (adjusted GM 95.4 pmol/L vs. never 74.5, p value = 0.02) and 16-epiestriol (20.4 vs. 16.8, p value = 0.05) particularly among users of lye-based hair relaxers. Positive associations between scalp burns and unconjugated estrogens were observed (e.g., unconjugated estrone: 5+ scalp burns 76.9 [59.6-99.2] vs. no burns 64.0 [53.7-76.3], p-trend = 0.03). No association was observed between use of skin lighteners and circulating estrogens. This study presents evidence that circulating 16-pathway estrogens (i.e., estriol and 16-epiestriol) may be increased in users of lye-based hair relaxer products. Among hair relaxer users, unconjugated estrogen levels were elevated in women with a greater number of scalp burns. In this population-based study of hair relaxer and skin lightener use among postmenopausal women in Ghana, altered estrogen metabolism was observed with hair relaxer use, particularly among women using lye-based products or with a greater number of scalp burns. In contrast, skin lightener use was not associated with differences in estrogen metabolism in this population. Continued investigation of the potential biological impact on breast cancer risk of hair relaxer use is warranted.

Hair product use and breast cancer incidence in the Black Women's Health Study.

Hair relaxers and leave-in conditioners and oils, commonly used by Black/African American women, may contain estrogens or estrogen-disrupting compounds. Thus, their use may contribute to breast cancer risk. Results of the few previous studies on this topic are inconsistent. We assessed the relation of hair relaxer and leave-in conditioner use to breast cancer incidence in the Black Women's Health Study, a nationwide prospective study of Black women. Among 50 543 women followed from 1997 to 2017, 2311 incident breast cancers occurred. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression for breast cancer overall and by estrogen receptor (ER) status. For heavy use (≥15 years of use for ≥7 times/year) of hair relaxers relative to never/light use (<4 years, no more than 1-2 times/year), the multivariable HR for breast cancer overall was 1.13 (95%CI: 0.96-1.33). Duration, frequency, age at first use and number of scalp burns were not associated with overall breast cancer risk. For heavy use of hair relaxers containing lye, the corresponding HR for ER+ breast cancer was 1.32 (95% CI: 0.97, 1.80); there was no association for non-lye products. There was no association of conditioner use and breast cancer. Results of this study were largely null, but there was some evidence that heavy use of lye-containing hair relaxers may be associated with increased risk of ER+ breast cancer. Consistent results from several studies are needed before it can be concluded that use of certain hair relaxers impacts breast cancer development.

637 Free Abdominal Tissue Transfer and Utilization of the Umbilical Stalk for “Tubular” Reconstruction in Ear, Nose and Throat Defects: A Case Series

Abstract Introduction Head and neck defects, whether from burns or cancer resections, are complex and often require free flap reconstruction. Radial forearm and anterolateral thigh (ALT) flaps are commonly used due to their thin and versatile nature. However, abdominal based free tissue transfer is one valuable alternative that can cover large defects and may become a more appropriate option on the reconstructive ladder when the defect includes reconstruction of a tubular structure, such as the external auditory canal, a neck tracheostomy/stoma site or an external nasal opening. We present a novel utilization of abdominal free tissue transfer for coverage of large ear and scalp burn defects as well as neck and midface defects with usage of the umbilical stalk for tubed reconstruction. Methods Four patients presented for reconstruction: two patients had sustained large ear and scalp burns resulting in complete ear loss; one had a large neck defect resulting from recurrent cancer resection which necessitated a laryngectomy and stoma creation; and one patient had a large central face defect post-cancer resection. All four patients underwent an abdominal based free tissue transfer with reconstruction of the external auditory canal in the ear and scalp burns, stoma creation in the neck defect, and the external nasal opening in the central face defect, all utilizing the vascularized umbilical stalk for the tubed reconstruction. Results All patients recovered post-operatively without any reported complications such as tubular stenosis or contracture while maintaining umbilical stalk tubular patency. Conclusions Reconstruction of a tubed structure in head and neck defects, whether the external auditory meatus, an external nasal opening or a neck stoma post burn or cancer resection, can be a difficult and challenging operation fraught with potential complications. We present a novel method of reconstruction of large defects employing the use of the uniquely thin and vascularized umbilical stalk for tubular reconstruction.

Scalp Burn Involving the Calvaria and Difficulty in Treatment: A Case Report

Scalp Burn Involving the Calvaria and Difficulty in Treatment: A Case Report

Reconstruction of Scalp Defects in Electrical Burns

Introduction: Electrical burn injury in India comprises a fair percentage of overall burn injuries, and they cause significant morbidity. Reconstruction of scalp defects often poses challenges to the plastic surgeon regarding the timing of surgery, choice of reconstruction, and postoperative management. The objective of this article is to throw light on various options for reconstruction of scalp defects as the involvement leads to significant morbidity. Materials and Methods: The study was conducted at a tertiary burn care unit. The period of this study was from 2016 to 2019. Retrospective analysis was done. Results: In this study, retrospective analysis of 40 cases of scalp burns was evaluated from 2016 to 2019. Out of these, 6 patients were managed with primary suturing, 8 patients underwent split-thickness skin graft, 24 patients required local flaps, and 2 patients were managed with extracorporeal radial forearm flap. There were no major complications. Minor complications like wound infection were seen in five of the local flap patients which were managed with antibiotics and regular dressing. Two patients had partial flap loss which was revised and managed conservatively. All flaps healed well. There was hair loss patch evident in patients where split-thickness graft was used. Conclusion: Thorough debridement of the wound is necessary in electrical burns. Smaller scalp wounds can be managed with split-thickness skin graft and local flaps, but larger defects should be managed with distant flaps and free flaps. This study shows that local flaps are the ideal choice for reconstruction of scalp defects due to their easy availability, minimal complications, and acceptable cosmesis.

Heat transfer during TTFields treatment: Influence of the uncertainty of the electric and thermal parameters on the predicted temperature distribution

Background and objectivesTumor Treating Fields (TTFields) is a technique currently used in the treatment of glioblastoma. It consists in applying an electric field (EF) with a frequency of 200 kHz using two pairs of transducer arrays placed on the head. Current should be injected at least 18 h/day and induce a minimum EF intensity of 1 V/cm at the tumor bed for the treatment to be effective. To avoid scalp burns, Optune, the device used to apply this technique in patients, monitors the temperature of the transducers and keeps them below 41 °C by reducing the injected current. The goal of this study was to quantify the impact of the uncertainty associated with the electric and thermal parameters on the predicted temperature of the transducers and of each tissue when TTFields were applied. MethodsWe used a realistic head model, added the two pairs of transducers arrays on the scalp and a virtual lesion, mimicking a glioblastoma tumor in the right hemisphere. Minimum, standard and maximum values for the electric and thermal properties of each tissue were taken from the literature after an extensive review. We used finite element methods (COMSOL Multiphysics) to solve Laplace's equation for the electric potential and Pennes’ equation for the temperature distribution. ResultsWe observed that the electric conductivity of the scalp and skull, as well as scalp's blood perfusion and thermal conductivity were the parameters to which tissue and transducers temperature were most sensitive to. Considering all simulations, scalp's maximum temperature was around 43.5 °C, skull's 42 °C, CSF's 41.2 °C and brain's 39.3 °C. According to the literature, for this temperature range, some physiological changes are predicted only for the brain. The average temperature of the transducers varied between 38.1 °C and 41.6 °C which suggests that modelling TTFields current injection is very sensitive to the parameters chosen. ConclusionsBetter knowledge of the physical properties of tissues and materials and how they change with the temperature is needed to improve the accuracy of these predictions. This information would likely decrease the predicted temperature maxima in the brain and thus help ascertaining TTFields safety from a thermal point of view.

Hostile Scalp Wound Reconstruction Using Acellular Dermal Matrix for Soft Tissue Augmentation.

The use of acellular dermal matrix (ADM) is well established in scalp burn reconstruction. However, its application in at-risk patients and hostile scalp wounds remains controversial and only described in the pediatric setting. This study aims to describe the pre-operative factors leading to the decision to use ADM in adult patients undergoing complex scalp reconstruction, and to describe the postoperative outcomes including wound breakdown and need for reoperation. This is a retrospective case series of patients undergoing scalp reconstruction with use of ADM. Data was collected from operations performed by a single surgeon over a period from January 2017 to October 2018. Nine patients underwent scalp reconstruction including placement of ADM during the study period. Seven patients were female, and median age was 64 years. Six patients had undergone prior craniotomies and three had undergone prior craniectomies for a variety of etiologies including neoplastic disease (n = 4), aneurysmal disease (n = 2), and trauma (n = 3). Wound breakdown or delayed wound healing necessitated reconstructive operations in all patients, 4 of whom had exposed/infected hardware that required removal. The median area of soft tissue defects was 30 cm. Two of the 4 patients with both benign and malignant tumors had been treated with radiation therapy, compromising the quality of the remaining adjacent scalp. Acellular dermal matrix was used in each setting to augment or buttress thin scalp. In 4 patients cranioplasty implants, hardware, or mesh were replaced concurrently. Two patients proceeded onto staged alloplastic cranioplasty without complication. Median follow up was 115 days. During follow up, only 1 patient suffered a major complication requiring reoperation to explant an osteomyelitic bone flap. Acellular dermal matrix can serve as an adjunct in hostile scalp reconstruction. Augmenting the areas of compromised scalp, especially over alloplastic cranioplasty material, can minimize the likelihood of future hardware exposure. Our study demonstrates its use in high-risk scalp wounds defined by frequent operation, chronic infection, and radiation.

Simple Method for Aesthetic Symmetrical Post Burn Reconstruction of the Temporal and Sideburn Subunits

Post burn scaring and reconstruction of the scalp iscommon condition, which is challenging to plastic surgeons.Which might lead to social deprivation and severe psychologicaltrauma, and patients always try to hide these areas withscarf, hats, wigs, etc…. Although these attempts are commonand useful for the vertex and occipital region, temporo-parietal,temporal, and sideburn are difficult to be camouflaged.Different ways of reconstruction were used including:Serial scar excision, follicular hair transplant, tissue expansion,regional or remote tissue transfer with local or free flaps havebeen described.Although tissue expansion is the best and most popularmethod for scalp reconstruction, the results might be unexpectedand displeasing. Searching on English speaking literature,in all previous studies, success was attributed to theexpansion process in relation to the size, location of thealopecia and donor area ignoring the importance of achievingthe exact or near normal pattern of hair line and symmetry ofthe temporal, temporo-partial and side burn regions. This isdue to the absence of a simple method to guide surgeons whileplanning and reconstructing this critical zone. In this study,I am presenting a simple method utilizing the tissue expansionfor reconstruction of sideburn, temporal, and temporo-partialalopecia to achieve satisfactory, symmetry and near normalreconstruction.This is a retrospective analysis of prospectively maintainedrecords of 29 patients, was conducted from February 2016 toMay 2018 in the Department of Plastic Surgery, Ain ShamsUniversity, Cairo, Egypt. Twenty nine patients with scalp burn alopecia of age 6 to 35 years were included in this study.All patients were examined and assessment was done byobjective and subjective analysis.The results shows that by using this simple method toreconstruct temporal and lateral side burn area, it is provenfrom the objective and subjective evaluation the aestheticoutcome was satisfactory, symmetrical and standardized.

586 Scalp Burn Injury Associated with Hair Highlight Treatment

Abstract Introduction Hair highlighting treatment has become popular at salons across the country. The ubiquity of this beauty treatment gives many people the impression that it is safe. The process of changing hair color differs between hair salons and hair stylists. We describe the cases of two teenage patients who received third degree burns from hair highlighting treatments. Differences in highlighting technique and treatment modality will be compared and contrasted. Methods As part of a quality assurance project looking at variation in scalp burn treatment and outcome, two patients were identified who experienced scalp burn injury due to hair highlighting. Patient 1 received a hot foil hair lighting application. After 5 minutes, the patient experienced tingling in the scalp and removed heat lamp and foils from hair. The first two weeks of treatment were administered by her primary care provider before the patient admitted to our burn facility, where topical collagenase was initiated. Forty two days after initial injury the patient underwent first surgery for debridement, followed by subsequent excision and grafting of scalp. Patient returned for tissue expansion nine months later. Patient 2 received a hair highlighting treatment of bleach and water. Patient 2 complained of burning and immediately her hair was washed out by the hairdresser. The patient was seen two weeks later in our clinic, and treated conservatively with mineral oil and antibacterial topical application. Patient was offered tissue expansion surgery but declined. Results Table 1. compares injury type, treatment and outcome in these two patients. Both injuries required significant time to heal, ranging between 56–70 days. Although similar injuries, mode of treatment differed at this same institution. Both patients made decisions based on school activities and fear or surgery, which prolonged time of conservative treatment. Patient 1 received psychological support and anti-anxiety medication prior to all treatments. After tissue expansion Patient 1 no longer required medication and had no sign of alopecia. Patient 2 has area of alopecia 2x2 cm. Neither patient requires further follow up, however Patient 2 could return for tissue expansion if desired. Conclusions Hair highlighting is a risk for serious scalp burn injury. Conservative treatment (often per patient preference) is associated with prolonged days to healing. Surgical intervention which includes subsequent tissue expansion, combined with psychological support and anxiety management results in good outcome. Applicability of Research to Practice Results from this analysis will be used to develop treatment protocols and staff education on scalp burn injury.

FORMATION OF GRANULATION TISSUE BY DRILLING HOLES IN THE CRANIUM AFTER CHEMICAL SCALP BURNS: A CASE STUDY

Although chemical burns constitute 3% to 5% of all burns, they are responsible for 30% of burn-related deaths. Chemical burns cause protein denaturation in physiological proteins by different mechanisms such as reduction, oxidation, corrosion, purification, salinization, and protoplasmic poisoning. Time is very important in the treatment of chemical burns. Chemical substances should be removed very quickly from the body. Chemical scalp burns (with bones) are a rare injury in clinical practice. In the case of scalp burns, including bones, it becomes an important problem when flab surgeries fail or cannot be performed. This study was planned to examine the formation of granulation tissue by drilling holes in the cranium after chemical scalp burns, and to determine the process of grafting and clinical practice.&#x0D; A 55-year-old male patient was admitted to the emergency department after a chemical burn (nitric acid). He was admitted to the burn center with 20% of the total chemical burn being in the third degree, especially on the head and chest area. The patient was treated with debridement. Since the cranial periosteum was burned, the defect was wide and there was a chemical burn for the second time, graft and flap surgeries could not be performed. Multiple holes were drilled on the skull. Approximately a month later, granulation was observed in all holes in the cranium. The granulated areas in the skull were cleaned and debrided. The defect in the cranium was closed with a split thickness graft. Approximately 15 days later, he was discharged from the hospital. Therefore, after exposure to nitric acid, more than half of the scalp was burned to the bone. After the necrotic tissues were cleaned, the skull bones appeared. Since graft and flap surgeries could not be performed, granulation was stimulated on the cranium by opening holes in the skull.

Closure of a full-thickness scalp burn that occurred during hair coloring using a simple skin-stretching method: A case report and review of the literature.

Full-thickness scalp burns secondary to hair coloring are rare; however, such defects can be large and complex reconstruction of hair-bearing tissue may be necessary. Many skin-stretching devices that use gradual traction have been applied to take advantage of the viscoelastic properties of the skin. A 21-year-old female patient was seen with a burn defect on her occipital scalp leading to exposed subcutaneous tissue after chemical application of hair coloring in a salon. The dimensions of the wound were 10 cm×5 cm, and a skin graft or flap would have been necessary to close the defect. Two long transfixing K-wires (1.4 mm) and paired 3-wire threads (23 gauge), which are readily available in most hospitals, were applied over a period of 12 days for trichophytic closure of the defect. The remaining scalp scars after primary trichophytic closure with this skin-stretching method were refined with hair follicle transplantation. This skin-stretching method is simple to apply and valuable for helping to close problematic areas of skin shortage that would otherwise require more complicated procedures. This case shows a relatively unknown complication of hair coloring and its treatment.

Scalp burn: Attention to cosmetics

Hair highlighting procedures are very common throughout the world. While rarely reported, potential adverse events can occur. We report the case of a 34 years old femal adult who underwent a hair highlighting procedure at local salon and sustained a chemical burn to the scalp.

Staged reconstructive treatment for extensive irregular cicatricial alopecia after burn.

For extensive irregular cicatricial alopecia after burn, effective and pleasing restoration of hair-bearing scalp remains challenging. In this article, the authors presented staged reconstructive treatment for extensive irregular cicatricial alopecia with the goal to achieve better and reliable results. A retrospective review of staged reconstructive treatment performed in 16 patients with extensive irregular cicatricial alopecia after burn was conducted. In stage 1, final flaps were designed at 1st. Tissue expanders were placed into the subgaleal plane and serially inflated with normal saline. In stage 2, scarring tissues were excised and the expanded hair-bearing flaps were advanced to the defect. Hair grafts were harvested from excessive hair-bearing scalps excised from the flaps and replanted. For patients with less satisfactory results, stage 3 was performed by hair transplantation. Cicatricial area, follicular unit density, survival rate of hair grafts, and patients’ satisfaction were measured before and after each stage. Thirteen patients received 3-stage treatment, and 3 received 2-stage treatment. Significant improvements in aesthetics and patient satisfaction were achieved in all the patients. No flap necrosis, implant exposure or hematoma was observed. Ideal, aesthetic, and reliable results could be obtained using staged reconstructive treatment for patients with extensive irregular cicatricial alopecia after burn.

Scalp as a donor site in children: Is it really the best option?

BackgroundSince 2003 we have used the scalp as a donor site for split skin grafts (SSGs) in major burns when there was a shortage of conventional donor areas. However, we seen a high incidence of complications, contrary to international experience. ObjectiveThe aim of this study was to analyze the results and complications related to the scalp as a donor site and to determine whether there is an association between our specific patient population and the complications encountered. MethodsA retrospective review of our scalp donor site outcomes over a 12-year period was conducted. The cohort included 25 patients, 15 of black African descent, nine of mixed race and one Caucasian. The various hair types were identified based on ethnicity and classified into eight types. Most of our patients had hair types VI–VIII. None of these patients had scalp burns and all received standard burn treatment. The SSGs were taken with an electric dermatome with a standard micrometric setting of 0.2mm. Complications were categorized into short- or long-term, with a mean follow-up time of 1.59years. ResultsThe mean age of the 25 children was 5.7years. Nineteen sustained flame burns and 6 sustained hot water burns, with a mean total body surface area of 44.9%. A total of 43 scalp procurements were performed in the 25 patients studied. The group of 15 black African patients (hair types VI–VIII) had a total of 22 procurements, the nine patients of mixed race (hair types III–V) had 18 procurements and the single Caucasian patient (hair types II–III) had two procurements. The median healing time was 15days, 11.8days and 8.5days, respectively, per group. Significant complications were encountered, including folliculitis 44%, non-healing wounds 52%, alopecia 16% and visible, hypopigmented scars 3%. One patient had a hypertrophic scar and no hair transfers to the recipient areas were observed. The various hair types correlated with the complications encountered. Five children, with an average burn size of 65.2% (range: 40–85%) died of sepsis. Due to the small sample size, the only statistically significant findings were related to the total body surface area of the burn and the number of times skin was harvested from the scalp, with a p-value of 0.005. The p-values for the healing times related to the first, second and third croppings, were p=0.022, p=0.00032 and p<0.001 respectively. ConclusionOur study suggests that in pediatric patients of black African descent (hair types VI–VIII) the scalp is not an ideal donor area, due to the unacceptably high incidence of complications. Hence, every precaution should be taken when it becomes necessary to harvest donor skin from the scalp.

Bipedicle flap for reconstruction of post-electric scalp burn defect

High-tension electric calvarial burns are extremely rare and difficult to reconstruct. Invariably, these are third- or fourth-degree-deep burns involving the full thickness of the bone. Historically, these wounds have been treated conservatively, adding to morbidity and prolonged treatment. The patient with high-tension electric calvarial burns presented to us two days after the injury with subsequent loss of full thickness of parietal bone. The defect was covered with a local bipedicled scalp flap. The bipedicle flap provides a simple and reliable method of reconstruction of full thickness scalp defect.