Case 52 Scalp Burn Reconstruction

Lauren O. Roussel and Albert S. Woo

Case 52 Scalp Burn Reconstruction

Case 52 (a, b) A 45-year-old man with history of burns to the scalp after a work-associated explosion presents for scalp reconstruction.

52.1 Description

  • Evidence of skin grafting overlying the vertex of the scalp

  • Notable alopecia on vertex extending to right side

  • Defect involving >50% of normal hair-bearing scalp surface

52.2 Work-Up

52.2.1 History

  • Etiology of injury, including mechanism and depth of burns

  • Time interval since injury

  • History of prior reconstruction

  • Medical comorbidities

    • Wound healing problems

    • Smoking history

    • Bleeding disorders

52.2.2 Physical Examination

  • Assess size of scar

  • Evaluate for areas of scalp laxity

  • Assess directionality of remaining hair

  • Assess for other scars or affected body regions

52.3 Treatment

  • Establish patient’s expectations for reconstruction

    • Correction of alopecia (bring in new hair-bearing tissue)

    • Improvement in hairline

    • Optimization of facial appearance (excise grafted regions and replace with local tissue, if possible)

52.3.1 Flap Coverage

  • Viable option for smaller defects of the scalp

  • Scalp tissue has less mobility than other parts of the body

  • Large flaps should be designed to optimize result and minimize tension

  • Common flap options:

    • Rotation

    • Advancement (V-Y)

    • Transposition

    • Orticochea (see Fig. 52.1)

    • Pinwheel (see Fig. 52.2)

      Fig. 52.1 Orticochea three-flap technique for coverage of large defects of the scalp.
      Fig. 52.2 Pinwheel flaps for closure of a circular defect.

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 52 Scalp Burn Reconstruction
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