Scalp Burn Reconstruction


Scalp Burn Reconstruction

Gwendolyn Hoben & Albert S. Woo
(a,b) A 26–year-old man burned in a house fire requesting reconstruction following initial treatment of scalp burns.


  • Irregular scarring and alopecia to the right occipital scalp

    • Extension to the superior neck and retroauricular region.

    • Defect involves ~ 25% of normal hair-bearing scalp surface.



  • Etiology of scar, including mechanism and depth of burns.

  • Time interval since injury and reconstruction.

  • Medical comorbidities

    • Wound- healing problems.

    • Smoking history.

    • Bleeding disorders.

  • Social support network.

Physical examination

  • Assess size of scar and degree of scalp laxity.

  • Assess directionality of remaining hair.

  • Assess for other scars or affected body regions.


  • Establish patient expectations for reconstruction.

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

    • Improvement in hairline.

    • Improvement in facial appearance (excise grafted regions and replace with local tissue, if possible).

Flap coverage

  • Viable option for smaller defects of the scalp.

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

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

  • Common flap options: Rotation, advancement (V-Y), transposition, pinwheel, Orticochea.

Tissue expansion

  • Defects of up to 50% of the scalp can be reconstructed.

  • Preferred technique for scalp reconstruction.

  • Multiple expanders may be used for a single defect. More than one expansion may be performed.

  • Incisions are designed perpendicular to axis of expansion, can be placed within lesion to allow future excision.

  • Subgaleal placement.

  • Internal ports are less convenient but have a lower risk for infection compared with external ports.

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Jun 18, 2020 | Posted by in General Surgery | Comments Off on Scalp Burn Reconstruction
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