Postoperative (pressure) alopecia following sacrocolpopexy

Abstract

Postoperative alopecia is a rare occurrence seen after a variety of surgical procedures performed under general anesthesia. The speculated cause is pressure-induced ischemia due to prolonged head immobilization. This case describes a patient who developed this complication after undergoing sacrocolpopexy. A 57-year-old postmenopausal Caucasian female was consented to undergo a robotic-assisted sacrocolpopexy, perineoplasty, and midurethral sling with possible conversion to an open procedure. The indication was symptomatic proximal and distal rectocele with foreshortened vagina. It was converted to laparotomy due to difficult presacral dissection. Her total operative time was 540 with 240 min in the Trendelenburg position. No intraoperative hypotension or excessive blood loss was noted. She started complaining of scalp pain in the postoperative recovery area. She developed soreness, crusting, and later alopecia in the same area. It was noted at her 3-week office visit. Referral was made for dermatology and anesthesiology evaluation. There was spontaneous full recovery by the 5th month. Postoperative alopecia is a rare condition mimicking alopecia areata but it is preceded by inciting events. There is some evidence to suggest that it is a preventable condition by frequent head repositioning during surgery. This case report is intended to increase the surgeon's awareness about this rare complication as its occurrence can be distressing for the patient.

Laparotomy or minimal invasive surgery in uterus transplantation: a comparison

“…In the robotic UTx procedure, the donor is placed in steep Trendelenburg position to allow adequate pelvic exposure. There exist reports of pressure alopecia due to the steep Trendelenburg position and pressure towards the back of the head (35,36) and in our ongoing Swedish trial we have experienced one case of pressure alopecia of around 5Â5 cm on the back of the skull, and this spontaneously reversed after one year (unpublished data). Other, complications that have in general been associated with robotic surgery are skin lesions, peripheral nerve injury, rhabdomyolysis and ocular complications including blindness (37).…”

Headgear-induced temporary pressure alopecia

“…The majority of case reports of pressure alopecia have been observed following extended surgical procedures, giving rise to the alternative name of postoperative alopecia (Abel and Lewis, 1960; Bagaria and Luck, 2015; Chang et al, 2016; Domínguez-Auñón et al, 2004; Huang et al, 2018; Iwai et al, 2009; Lawson et al, 1976; Matsushita et al, 2011; Wiles and Hansen, 1985). Other causes of pressure alopecia reported in the literature include electroencephalogram electrodes (Kunapareddy et al, 2018; Morris et al, 1992), headbands (Sano et al, 2018), fixed head positioning while watching television (Thiem et al, 2016) and breakdancing (Bonifazi, 2006).…”

“…It presents as one or more rounded patches and exhibits clinical phases of activity, inactivity and regrowth (Eudy and Solomon, 2006). Unlike pressure alopecia, alopecia areata has no prodromata; pressure alopecia, however, follows prolonged pressure to an area of the scalp and may be preceded by erythema, swelling, exudate, crusting and tenderness (Abel and Lewis, 1960; Bagaria and Luck, 2015; Chang et al, 2016; Wiles and Hansen, 1985). Abel and Lewis (1960) also reported faster and prompter hair regrowth in areas of pressure alopecia compared to alopecia areata.…”