Hair Transplantation on the Baldness Region with Free Latissimus Dorsi Flap for Scalp Reconstruction: A Case Report

Abstract

Scalp reconstruction, particularly with complex defects and infection risks, often favors microvascular free flaps. However, this method can result in unavoidable alopecia and undesirable aesthetics. This report describes a novel case where hair transplantation via follicular unit extraction (FUE) was applied to a free myocutaneous flap. A 44-year-old woman with Moyamoya disease suffered intracerebral hemorrhage a decade ago. Craniotomies and autologous bone cranioplasties led to wound dehiscence, with subsequent failed local flaps and skin grafts, and identification of a methicillin-resistant Staphylococcus aureus infection. The final scalp defect, measuring 13 × 9 cm, was reconstructed using a free myocutaneous latissimus dorsi flap. Nine years post-surgery, a 1,500-unit FUE hair transplantation procedure was conducted. The transplanted hair exhibited robust survival with adequate blood supply, achieving a satisfactory 80 to 85% survival rate at 12 months. This resulted in a notable improvement in the patient's external alopecia, with reported high levels of satisfaction. Free flaps offer a valuable method for scalp defect reconstruction; however, they may not ensure optimal aesthetic satisfaction due to alopecia. Nonetheless, successful FUE hair transplantation on a myocutaneous free flap can yield satisfactory aesthetic results.

Keywords

baldness - scalp - free flap - reconstructive surgery

Authors' Contributions

Conceptualization: J-U.P. Data curation: M.W.H. Formal analysis: M.W.H. Methodology: J.S.M. Project administration: J.U.P. Visualization: M.W.H. Writing—original draft preparation: M.W.H. Writing—review and editing: J.U.P. All authors read and approved the final manuscript.

Ethical Approval

The study was approved by the Institutional Review Board of Seoul National University Boramae Medical Center (IRB No. 10-2023-51) and performed in accordance with the principles of the Declaration of Helsinki.

Patient Consent

The patient provided written informed consent for the publication and the use of their images.

Note

This article was presented at PRS Korea 2023 on November 10, 2023.

Publikationsverlauf

Eingereicht: 05. Januar 2024

Angenommen: 28. April 2024

Artikel online veröffentlicht:
10. Juni 2024

• References

• 1 McLean DH, Buncke Jr HJ. Autotransplant of omentum to a large scalp defect, with microsurgical revascularization. Plast Reconstr Surg 1972; 49 (03) 268-274
• 2 Na Y, Shin D, Choi H, Kim J, Lee M. Scalp reconstruction using the reverse temporalis muscle flap: a case report. Arch Craniofac Surg 2022; 23 (03) 134-138
• 3 Boeckx WD, van der Hulst RR, Nanhekhan LV, De Lorenzi F. The role of free flaps in the treatment of persistent scalp osteomyelitis. Neurosurgery 2006; 59 (1 Suppl 1): ONS64-ONS67 , discussion ONS64–ONS67
• 4 Beasley NJ, Gilbert RW, Gullane PJ, Brown DH, Irish JC, Neligan PC. Scalp and forehead reconstruction using free revascularized tissue transfer. Arch Facial Plast Surg 2004; 6 (01) 16-20
• 5 Yoo H, Moh J, Park JU. Treatment of postsurgical scalp scar deformity using follicular unit hair transplantation. BioMed Res Int 2019; 2019: 3423657
• 6 Blackwell KE, Rawnsley JD. Aesthetic considerations in scalp reconstruction. Facial Plast Surg 2008; 24 (01) 11-21
• 7 Veir Z, Kisić H, Mijatović D. et al. Hair transplantation on a free microvascular latissimus dorsi flap: case report. Ann Plast Surg 2014; 73 (06) 668-669
• 8 Araki Y, Uda K, Yokoyama K. et al. Surgical designs of revascularization for Moyamoya disease: 15 years of experience in a single center. World Neurosurg 2020; 139: e325-e334
• 9 Houkin K, Ishikawa T, Yoshimoto T, Abe H. Direct and indirect revascularization for moyamoya disease surgical techniques and peri-operative complications. Clin Neurol Neurosurg 1997; 99 (Suppl. 02) S142-S145
• 10 Kwon H, Kim HJ, Yim YM, Jung SN. Reconstruction of scalp defect after Moyamoya disease surgery using an occipital pedicle V-Y advancement flap. J Craniofac Surg 2008; 19 (04) 1075-1079
• 11 Hussussian CJ, Reece GP. Microsurgical scalp reconstruction in the patient with cancer. Plast Reconstr Surg 2002; 109 (06) 1828-1834
• 12 Desai SC, Sand JP, Sharon JD, Branham G, Nussenbaum B. Scalp reconstruction: an algorithmic approach and systematic review. JAMA Facial Plast Surg 2015; 17 (01) 56-66
• 13 Spector JA, Glat PM. Hair-bearing scalp reconstruction using a dermal regeneration template and micrograft hair transplantation. Ann Plast Surg 2007; 59 (01) 63-66
• 14 Parsley WM, Perez-Meza D. Review of factors affecting the growth and survival of follicular grafts. J Cutan Aesthet Surg 2010; 3 (02) 69-75
• 15 Barrera A, Phillips LG, Barrera FF. Hair grafts in lower leg reconstruction. Plast Reconstr Surg 2007; 120 (02) 22e-25e
• 16 Irawati Y, Fitri MAR, Natalia MER, Atmodiwirjo P, Ramadan MR, Triatmoko SE. A case report of reconstruction of ocular and complete upper eyelid avulsion with severe facial soft tissue injuries using anterolateral thigh free flap. Int J Surg Case Rep 2021; 82: 105856
• 17 Levesque AY, Schalet BJ, Dolph JL. Beard reconstruction using hair grafts in a free flap. Can J Plast Surg 2011; 19 (04) 151-152
• 18 Baumeister S, Peek A, Friedman A, Levin LS, Marcus JR. Management of postneurosurgical bone flap loss caused by infection. Plast Reconstr Surg 2008; 122 (06) 195e-208e
• 19 Tokoro K, Chiba Y, Tsubone K. Late infection after cranioplasty–review of 14 cases. Neurol Med Chir (Tokyo) 1989; 29 (03) 196-201
• 20 Li Z, Ye L, Cheng H. et al. Delayed infection occurring seventeen years after cranioplasty: are previously implanted materials permanently safe?. J Craniofac Surg 2020; 31 (02) 472-474
• 21 Rassman WR, Bernstein RM, McClellan R, Jones R, Worton E, Uyttendaele H. Follicular unit extraction: minimally invasive surgery for hair transplantation. Dermatol Surg 2002; 28 (08) 720-728
• 22 Harris JA. Follicular unit extraction. Facial Plast Surg Clin North Am 2013; 21 (03) 375-384