Scalp Expansion Research Articles

Depressed Fracture of Calvarial Bone following Rapid Scalp Expansion for Post-burn Alopecia in a Child

SUMMARYDepressed calvarial fracture as a complication of scalp expansion in a 3 1/2-year-old girl who underwent 8cm scalp expansion over 48 days is being reported. A technique for placement of tissue expander through multiple small radically placed incisions is described to prevent implant exposure.

Aesthetic results of treatment of large alopecia with total scalp expansion.

In the last 7 years, 18 patients with large alopecia (approximately one-third of hair-bearing scalp) were treated with 31 tissue expansion procedures. In the previous 44 patients, with various degrees of alopecia treated with conventional tissue expansion technique, the major complication rates were as high as reported in the relevant literature. The clinical experience gained with these cases led us to make some modifications in the surgical technique. We applied some simple surgical maneuvers and Z-plasties to the last 18 cases with large alopecia. The major complication rate of 3.2% observed in this study is comparable to the lower complication rates of 6-12% reported in the literature for different degrees of alopecia. We believe that these simple modifications and meticulous approach improve the results of conventional treatment of alopecia with tissue expansion and flap. In this paper, details of the insertion technique and reconstructive procedures and their relevance to the success rate of the aesthetic treatment of the large alopecia are discussed.

From the LiteratureBook Review: Dermatology ClinicsArticle Review: Ineffectiveness of Acute Scalp Expansion

# Book Review: Dermatology Clinics {#article-title-2} Hair Restoration and Laser Hair Removal, April 1999 , Copyright © by W.B. Saunders; Dow Stough, MD The majority of written and oral debate in hair transplantation is related to technique. What are the instruments needed to create the most

Ineffectiveness of Acute Scalp Expansion

Ineffectiveness of Acute Scalp Expansion

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.

The effects of scalp expansion on the cranial bone: a clinical, histological, and instrumental study.

The effects of chronic compression of the cranial bone due to progressive expansion of the scalp have been investigated. Ten patients were studied, 6 adults and 4 children, who were treated for congenital (microtia) or acquired (burns or traumatic) deformities by chronic expansion over a 2-month period. All underwent computed tomography scans of the expansion site prior to introduction of the expansion device, immediately before removal, and at 9 months after the operation. A case of postburn alopecia was lost to the study, because the patient, who had ultimated scalp expansion, did not return for flap advancement. Instead, she came back 3 months later, without the expander, which had been removed at another institution following an automobile accident. In this case, because of slower healing, we performed computed tomography scans 18 months postoperation. During the second procedure (expander removal and flap transposition), bone samples for histological examination were collected directly underneath and along the perimeter of the expanders. Macroscopically, the bone appeared thinned and had a reduced convexity. This reaction, although temporary, appeared more intense in the children and in the posttraumatic cases. Histological examination showed osteoclastic activation, bony hypotrophy, and reaction (deposition of osteoid matrix) under the device, with consequent bone resorption and remodeling. A marked hyperplasia with a hyperostotic reaction was observed around the expanders. At 9 months postoperation, in most cases, a complete normalization was confirmed by computed tomography scans. Expansion of target (fontanellar and sagittal) areas of the skull in children, as well as previous trauma to both scalp and skull should be taken into consideration as a risk factor. Further investigations are suggested.

Intra-operative scalp expansion for wound closure without tension in craniosynostosis operation — technical innovation

Primary scalp wound closure using intra-operative scalp expansion in a craniosynostosis operation is described. Since this method enables easy scalp expansion, it is considered to be a useful adjunctive technique which should be taken into account when closing scalp wounds in craniosynostosis surgery, where the risk exists of cranial expansion-induced compression and deformity of the remodelled bone flaps after bone fixation.

New devices for scalp reduction. Intraoperative and prolonged scalp extension.

Scalp reduction for male pattern and other extensive, permanent crown-vertex alopecias has been a beneficial, adjuvant procedure in hair replacement surgery and has been augmented by unsightly and sometimes painful intraoperative and chronic scalp expansion techniques. Ten patients underwent scalp reduction for male pattern baldness utilizing intraoperative Sure-Closure, a skin-stretching device. Ten patients had Frechet Extenders placed under the scalp during their scalp reductions with subsequent removal 28 days later followed immediately by second reduction procedures. The skin-stretching device, Sure-Closure, allowed the excision of 20%-30% more alopecic scalp during scalp reduction than what would have been possible with scalp reduction alone. The Frechet Extender when combined with a lazy S excision pattern for scalp reduction procedures generated between 25% and 50% more excision of alopecic scalp than with scalp reduction alone. Scalp reduction procedures can be more effectively performed with minimal complications and fewer reductions required per patient using either intraoperative scalp extension with the Sure-Closure device or chronic scalp extension with the Frechet Extender.

Severe electric burn of the skull

We report a case of severe injury of the scalp and skull caused by high tension electric current. The patient developed tetraplegia. The surgical steps undertaken are also described. We used two consecutive free flaps which failed 5 days after each operation. We discuss the possible causes for flap failure, which we think was due to damaged receptor vessels. The wound was closed after expanding the adjacent scalp. Scalp expansion was an uneventful procedure, however infection of the cavity developed. We overcame this problem by an aggressive approach (cavity irrigation, daily expansion and systemic antibiotherapy). The use of a synthetic mesh to avoid cerebral herniation through the bone defect is also described.

Preexpansion Galeal Scoring

Preexpansion scoring releases the inflexible galea, permitting more rapid expansion of the scalp. In addition, when comparing this procedure with conventional scalp expansion, patients reported less pain when the galea was incised prior to insertion of the tissue expanders.

Scalp Expansion for the Treatment of Male Pattern Baldness

Scalp Expansion for the Treatment of Male Pattern Baldness

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.

Jin Yi-tao et al. Scalp expansion in the treatment of cicatricial alopecia. (Chinese)

Jin Yi-tao et al. Scalp expansion in the treatment of cicatricial alopecia. (Chinese)

Infection and exposure in scalp expansion ? a successful outcome

A problem case of a scalp reconstruction in which tissue expanders were placed under a fresh scalp split-thickness skin graft donor site is presented. The pockets of the expanders became infected and one expander became exposed. Expansion was continued using continuous irrigation, and the scalp reconstruction initially planned was successfully achieved.

Hair Replacement Techniques: An Overview

From Orentreich's initial studies of the donor and recipient dominance of disease and of dermatologic conditions and his translation of those observations into punch-graft hair transplantation, a number of innovations in hair replacement have occurred. Many of these have been modifications and improvements of punch-graft techniques. Others have had major impacts on the treatment of baldness, such as flaps, scalp reduction, and tissue expansion. It is the combination of techniques, especially tissue expansion and punch-graft transplantation, that seems to hold the greatest promise for surgical treatment of baldness. Whether the hair replacement surgeon performs all of these procedures or not, he or she must be aware of the benefits of all of them and take them into consideration in developing a total plan for the individual patient. The hair transplant surgeon must also be aware that procedures desirable during the earlier stages of baldness may need to be modified with other types of surgery later in life as the alopecia becomes more developed, especially in the face of imprecise genetics in male-pattern baldness. The hair replacement surgeon not only must be aware that such modification may be necessary, but also must be knowledgeable about what those options entail. For example, tissue expansion may be a desirable adjunctive treatment with progression of baldness and would be possible if the parietal area has not been extensively harvested for punch grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

Scalp Expansion for Male Pattern Baldness

Male pattern baldness may be effectively eliminated in most patients through the use of soft-tissue expansion. Expansion affords larger temporo-parieto-occipital flaps with a more easily closed donor defect. Differential expanders are used to eliminate hippocratic male pattern baldness through a massive scalp reduction and simultaneous reconstruction of an anterior hairline.

Expansion-Assisted Treatment of Male Pattern Baldness

Scalp expansion has been combined with scalp reduction and flap procedures for the treatment of male pattern baldness. Expansion offers the advantages of a safe and reliable procedure, as well as more coverage in a shorter period of time. The techniques described involve bilateral temporal parietal occipital (TPO) expanders followed by either a frontal TPO flap and contralateral scalp reduction or bilateral TPO flaps. Both procedures leave areas of baldness in patients with more extensive losses (Juri classes II and II). Further expansion may be used for further coverage of residual bald areas.

Scalp expansion flaps

A mean 5 year review of 20 patients who had surgery for localised alopecia of the scalp is presented. The technique of using scalp expansion flaps is described and evaluated: it is associated with a low morbidity and high patient satisfaction rate; it provides an excellent one-stage procedure for intermediate size defects and, in the frontal area, for larger defects. Particular emphasis is laid on making incision lines at right angles to the direction of hair growth in order to cover stretched scars, and in performing Z-plasties when closing small scalp defects. Finally, a rationale for the treatment of localised areas of baldness according to their size is put forward.

Alopecia reduction by scalp expansion.

Areas of alopecia may be eliminated by scalp expanders. This is accomplished by subgaleal placement of soft tissue expanders under normal scalp adjacent to defect. Subsequent inflation and advancement of the expanded scalp resurfaces the defect with an excellent aesthetic result.