Scalp Burn Reconstruction



10.1055/b-0034-97731

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.


Description




  • 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.



Work-up



History




  • 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.



Treatment




  • 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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