Scalp expansion: Surgical considerations and possible future directions

Raposio, Edoardo

doi:10.4103/ijps.ijps_209_17

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…During the expansion process, the epidermis exhibits increasing mitotic activity, and the dermis thins significantly, which is frequently masked by the thick fibrous capsule formation all around the expander, resulting in limitation in flap mobility during the reconstruction process. [22][23][24] Therefore, the multidirectional relaxing incision during scalp wound closure provides improved flap mobility, resulting in a decreased risk of wound margin tension and dehiscence. 23,[25][26][27] According to Bilkay et al, 28 there was no need for capsule excision, but only scoring with great attention, to release the tightness without affecting the blood supply.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Anterior Capsulotomy and Basal Capsulectomy Adherent to Expanded Scalp Flap During Alopecia Reconstruction in Pediatric Burned Patients

2023

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Background: Scalp expansion is an optimal treatment for alopecia resulting from burn injuries, especially in the pediatric population through providing highly vascularized adjacent local tissues with optimal hair density, color matching, texture, and hair-bearing characteristics. The aim of this study was to evaluate the efficacy of anterior capsulotomy and basal capsulectomy adherent to expanded scalp flap during alopecia reconstruction with scalp expansion in pediatric burned patients. Methods: The study was conducted on 127 patients with an age range of 5 to 19 years who presented with postburn alopecia accompanied by hairline loss. The patients were divided into 2 groups: group I consisted of 58 patients who were operated on using conventional technique, and group II consisted of 69 patients who were operated using modified technique including basal capsulectomy on the skull side and anterior capsulotomy on the expanded scalp flap. Results: The Hairdex, a validated questionnaire of Hair-Specific Health-Related Quality of Life measures, showed that percentage of satisfaction concerning outcomes was 91.50%, psychological well-being was 95%, and self-confidence was 84.30% in group II, compared with 63%, 55.70%, and 66.20%, respectively, in group I. This significant values had a great positive effect on patient satisfaction, changing child's behavior and self-confidence. Conclusion: Although physiological background of tissue expansion is the same, proper flap design with anterior capsulotomy on flap undersurface and basal capsulectomy on the skull side improve results of the traditional method significantly and minimize the complication rate. These surgical modifications provide maximum benefits from expanded tissue, with restoration of the hairline and a uniform hair direction.

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Section: Discussionmentioning

confidence: 99%

The Efficacy of Anterior Capsulotomy and Basal Capsulectomy Adherent to Expanded Scalp Flap During Alopecia Reconstruction in Pediatric Burned Patients

2023

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“…However, clear-of-tumor defect margins are mandatory because of their movement from the original position. An alternative, not present in our review, may be represented by a primary reconstruction with skin grafting followed by delayed, subgaleal 34 or external, 35 scalp expansion in case of wide defects or necessity to wait for safe monitoring. Local flaps, in fact, are successfully employed in small (<50 cm 2 ) defects, 12 , 16 , 24 , 25 , 27 whereas they need association with skin grafts in case of wider wounds.…”

Section: Discussionmentioning

confidence: 99%

Surgical Reconstruction following Wide Local Excision of Malignant Melanoma of the Scalp

Baldelli

Mangialardi

Salgarello

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Scalp reconstruction in cases of melanoma excision can be challenging due to specific functional and aesthetic outcome requirements. Reconstructive techniques reported in the literature were reviewed to establish whether a surgical algorithm for the management of melanoma of the scalp may be deduced. Methods: A literature search was conducted to evaluate reconstructive strategies after melanoma wide local excision of the scalp according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria were English language, diagnosis of melanoma of the scalp, and the presence of the following data: characteristics of the residual defect (width and depth), type of reconstruction, follow-up, and surgical outcome. Results: Six hundred twenty-five records were identified after excluding the duplicates; 48 full-text articles were assessed for eligibility, and 17 records were selected for inclusion. A total of 39 patients were included in the review. The majority of patients (n = 20) underwent skin grafting subsequent to dermal regeneration template positioning. Local flaps (n = 10), free flaps (n = 7), skin grafting alone (n = 1), and dermal regeneration template positioning alone (n = 1) were less frequent. Conclusions: Numerous reconstructive strategies for the scalp are described in the literature. Melanoma patients present a greater variability in terms of general health conditions and social needs that must be taken into account while choosing the most suitable procedure.

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“…As regard flap loss, seven studies showing partial flap loss with total event rate 9.010 with insignificant heterogeneity between studies as shown in table [4]; eight studies showing total graft loss with total event rate 7.323 with significant heterogeneity between studies table [5], and two studies showing donor site morbidity with total event rate 19.869 with significant heterogeneity between studies as shown in figures [3]; five studies showing Revision surgery with total event rate 16.128 with insignificant heterogeneity between studies as shown in table [6].…”

Section: Meta-analysismentioning

confidence: 99%

“…Several variants exist, including the temporoparietal fascia flap [5] , 5. Tissue expander: Patients with post-surgical scalp baldness should seriously consider this surgery [6] , 6. Drilling of the diplopic space and skin grafting: The outer table of the skull can be drilled to access the diplopic area.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of Scalp Defects: A Meta-Analysis Study

Ali

Ahmed

Omran

2023

International Journal of Medical Arts

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Article informationBackground: Scalp deficiencies can be caused by a number of different etiological reasons, including tumor extirpation, infection, burns, or trauma to this special region of the human body. The scalp can be reconstructed in a number of ways, including through primary closure, skin grafting, local flaps, tissue expansion, or free tissue transfer. Aim of the work:To evaluate the various methods utilized for reconstructing scalp deformities; to get better surgical choice, through meta-analysis regarding defect size, depth, location, hair line, alopecia risk and aesthetic appearance.Patients and Methods: Recent clinical trials or cluster trials, as well as retrospective compared cohort studies, were included in this Metaanalysis. Study was conducted on human subjects with reconstruction of scalp defects. Review of the Methods Used in Reconstructing Scalp Defects; to get better surgical choice, through meta-analysis regarding defect size, depth, location, hairline, alopecia risk and aesthetic appearance.Results: A total of 393 cases had complete healing as regard complications founded in form of Hematoma in 18 cases, infection in 4 cases, seroma in 3 cases, wound dehiscence in 63 cases, Distal flap necrosis in 1 case, Partial flap loss in 13 cases, total Graft loss in 13 cases. Conclusion:Using local flaps to repair scalp abnormalities is a straight forward operation that does not often require extensive postoperative care and can be completed in a short amount of time with minimal risk. A local scalp flap is the preferred method for reconstructing even a big and complex scalp defect, such as one that involves the cranium or the dura. Our findings suggest that problems from local axial flap applications were infrequent and did not significantly impact flap survival.

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Scalp expansion: Surgical considerations and possible future directions

Cited by 6 publications

References 16 publications

The Efficacy of Anterior Capsulotomy and Basal Capsulectomy Adherent to Expanded Scalp Flap During Alopecia Reconstruction in Pediatric Burned Patients

The Efficacy of Anterior Capsulotomy and Basal Capsulectomy Adherent to Expanded Scalp Flap During Alopecia Reconstruction in Pediatric Burned Patients

Surgical Reconstruction following Wide Local Excision of Malignant Melanoma of the Scalp

Reconstruction of Scalp Defects: A Meta-Analysis Study

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