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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