88 Scalp Repair Using Flaps and Tissue Expanders

E. Antonio Mangubat

Summary

Repair of scalp defects poses several surgical and aesthetic challenges. The repair and/or excision of the existing defect is often difficult; however, the cosmesis of the repair is often the most difficult challenge because without careful planning, excision of the defect may leave unsatisfactory cosmesis. Hair transplantation after expanded flap advancement is often useful to camouflage scarring, but care must be taken to preserve vital vasculature. Furthermore, understanding of normal hair anatomy, morphology, and anticipating future hair loss is critical to achieving long-lasting satisfying results. Further challenges include conditions that compromise scalp viability, which make tissue more difficult to treat, such as trauma and residual effects of radiation therapy after cancer treatment. Contemporary techniques in hair restoration surgery allow creation of natural and undetectable results, but these techniques are often unsuitable for repairing large scarred areas of hair loss. By employing older techniques of scalp reduction and tissue expansion, excision of many large scarring defects can be made possible. Combining older methods with modern hair restoration surgery permits the satisfactory treatment of many previously untreatable conditions. This chapter will concentrate on tissue expansion as a significant tool for repairing large scalp defects.

Schlüsselwörter

tissue expansion - tissue expander - scalp reconstruction - scalp defect - scalp flap

• 1 Nordström RE. “Stretch-back” in scalp reductions for male pattern baldness.. Plast Reconstr Surg 1984; 73 (3) 422-426 PubMed (PMID: 6701217)

• 2 Norwood OT, Shiell RC, Morrison ID. Complications of scalp reductions.. J Dermatol Surg Oncol 1983; 9 (10) 828-835 PubMed (PMID: 6352759)

• 3 Brandy DA. The bilateral occipito-parietal flap.. J Dermatol Surg Oncol 1986; 12 (10) 1062-1066 PubMed (PMID: 3760314)

• 4 Neumann CG. The expansion of an area of skin by progressive distention of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear.. Plast Reconstr Surg (1946) 1957–1962; 19 (2) 124-130 PubMed (PMID: 13419574)

• 5 Radovan C. Breast reconstruction after mastectomy using the temporary expander.. Plast Reconstr Surg 1982; 69 (2) 195-208 PubMed (PMID: 7054790)