Abstract
Background
For a large lesion of the scalp (e.g., up to 50% scalp loss), restoration of the scalp with a hair-bearing scalp flap to achieve a pleasing aesthetic outcome and hair growth matched to the direction of the lesion, especially for a hemiscalp defect in children, often becomes very difficult and challenging for plastic surgeons.
Methods
Treatment was performed for 18 children with severe hemiscalp losses after burns. The technique was carried out by initially positioning a tissue expander in the subgaleal pocket of the scalp and serially inflating it with normal saline in 5- to 7-day intervals for about 3 months. Thereafter, a “flying-wings” expanded scalp flap was designed by combining advancement and rotation flap transplantation principles. This design was based on at least one nominated vascular system of the scalp used as the pedicle, with the wings often working to correct the distant part of the lesion in which the hair direction is greatly changed. After the lesion was excised, the expanded hair-bearing flap was advanced and rotated to the recipient site when the expander was removed.
Results
For the 18 patients, the flap used for hemiscalp reconstruction could be transferred to repair the hemiscalp loss totally (for 17 patients) or mostly (for 1 patient) in a single-tissue expansion process without flap necrosis. The patient with a remaining lesion was treated completely with a secondary tissue expansion in the postauricular area. All the patients showed good aesthetic results, with the hair growth direction matching the recipient site well.
Conclusions
The described technique strongly indicates that tissue expansion is a simple, safe, and efficient technique for large scalp restoration. The “flying-wings” design of the expanded scalp flap can properly distribute the expanded hair-bearing scalp in the recipient site.
Similar content being viewed by others
References
Wells MD (2006) Scalp reconstruction. In: Mathes SJ (ed) Plastic Surgery, 2nd edn. WB Saunders, Philadelphia
Nordström REA (1996) Tissue expansion. Butterworth Heinemann, Boston
Radovan C (1984) Tissue expansion in soft tissue reconstruction. Plast Reconstr Surg 74:482
Argenta LC, Watanabe JJ, Grabb WC (1983) The use of tissue expansion in head and neck reconstruction. Ann Plast Surg 11:31
Fan J (1991) Tissue Expansion. Ph.D thesis. Beijing Union Medical University, Beijing
McCauley RL, Oliphant JR, Robson MC (1990) Tissue expansion in the correction of burn alopecia: classification and methods of correction. Ann Plast Surg 25:103
Wieslander JB (1991) Tissue expansion in the head and neck: a 6-year review. Scand J Plast Reconstr Surg Hand Surg 25:47
Gurlek A, Alaybeyoglu N et al (2004) Aesthetic reconstruction of large scalp defects by sequential tissue expansion without interval. Aesth Plast Surg 28:245–250
Nordström REA (1984) “Stretch-back” in scalp reductions for male pattern baldness. Plast Reconstr Surg 73:422
Nordström REA, Devine JW (1985) Scalp stretching with a tissue expander for closure of scalp defects. Plast Reconstr Surg 75:578
Unger W, Nordtrom R (1988) Hair transplantation, 2nd edn. Marcel Dekker, New York
Bernstein R (1998) Standardizing the classification and description of follicular unit transplantation and mini-micrografting techniques. Dermatol Surg 24:957–963
Anderson RD (1993) The expanded “BAT” flap for treatment of male pattern baldness. Ann Plast Surg 31:385–391
Fan J, Yang P (1997) Aesthetic reconstruction of burn alopecia by using expanded hair-bearing scalp flaps. Aesth Plast Surg 21:440–444
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fan, J., Liu, L., Tian, J. et al. The Expanded “Flying-Wings” Scalp Flap for Aesthetic Hemiscalp Alopecia Reconstruction in Children. Aesth Plast Surg 33, 361–365 (2009). https://doi.org/10.1007/s00266-009-9330-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-009-9330-3