Clinical efficacy of expanded scalp flap combined with laser hair removal on frontal lesions / 中华医学美学美容杂志

Objective To explore the clinical results of repairing frontal lesions with the combination of the expanded scalp flaps and postoperative laser hair removal.Methods There were 10 patients involved between May 2014 through May 2016 in our department.In the first stage,the expanders were implanted to the pockets under the scalp.In the second stage,the wounds,after lesion removal,were covered by the expanded scalp flaps.In the third stage,laser hair removal was performed 2 weeks postoperatively for 4 to 6 times until complete removing the hair.Results All the lesions were repaired with good results.The incisions healed primarily.The scalp flaps survived without nec rosis.The hair on the flap was removed completely.The color and texture of the flap were similar to these of the adjacent skin.The satisfactory results of the appearance were achieved in all the patients.Conclusions The combination of the expanded scalp flap and laser hair removal is an effective method for the repairing of the frontal lesion.

Reconstruction of Postburn Sideburn and Frontal Hairline Alopecia by Various Tailored Scalp Flaps Transfer

PURPOSE: Reconstruction of sideburn and frontal hairline alopecia after burn injuries is one of the challenging tasks in reconstructive surgery. We report on the successful experiences to reconstruct the sideburn and frontal hairline alopecia with various scalp flaps such as Beak scalp flap, scalp rotation flap, scalp transposition flap and scalp expansion operation. METHODS: We experienced the patients who had postburn scalp alopecia after severe facial burn injuries. Among them we selected 8 patients of postburn sideburn and frontal hairline loss and reconstructed with variable scalp flaps. The types of scalp flaps for reconstruction were the Beak scalp flap which is made of the extended postauricular scalp flap combined with the central scalp rotation flap, scalp rotational flap, scalp transposition flap, and scalp expansion operations. We studied the indication of the transferred various scalp flaps for each case considering the size and shape of hair loss lesion, complications, problems of donor site, appearance of reconstructed frontal hairline and sideburns through follow survey. The follow-up periods were 3 months to 2 years. RESULTS: We experienced 8 patients of postburn sideburn and frontal hairline alopecia. Patients' age ranged from 13 to 16 years. male to female ratio was 2:6. Reconstruction methods were 1 case of Beak scalp flap, 1 case of scalp rotation flap, 1 case of scalp transposition flap and 5 cases of scalp expansions. All transferred scalp flaps were completely survived. As complications, 1 case hematoma, 1 case partial edge extrusion of expander, 1 case of persistent headache in scalp expansion operation were noted. There were no remarkable problems in scalp donor site. After 3 months to 2 years follow up, satisfactory results were obtained in all patients. Illustrated Case: The 31-years-old female patient had loss of right frontal hairline, sideburn caused by flame burn. With aid of 3D computerized graphic design, the extended posterior auricular scalp flap with the central frontal scalp rotation flap, which is called as the Beak scalp flap, is a newly designed scalp flap for correction of her frontal hairline and sideburn alopecia. The size of the central frontal scalp rotation flap was 12x11 cm, and the size of the extended postauricular scalp flap was 7x1.5 cm. This flap is elevated simultaneously and could cover the sideburn and frontal hairline alopecia in a single procedure. At postoperatively, the transferred the Beak scalp flap was survived completely. The 9 months follow-up after operation, well reconstructed her right sideburn and frontal hairline was shown. CONCLUSION: For reconstruction of postburn sideburn and frontal hairline alopecia, the scalp flaps transfer should be precisely design in accordance with size, location of hair loss, direction of hair, and also it is emphasized to minimize postoperative scalp donor scars. We had successful reconstruction of postburn sideburn and frontal hairline alopecia by the Beak scalp flap, as a newly designed the composite scalp flap, which is made of the extended postauricular scalp flap combined with the central frontal scalp rotation flap, this flap can be used for reconstruction of loss of sideburn and frontal hairline in a single stage procedure. And also we have used scalp rotation flap, scalp transposition flap, and scalp expansion operations for this purpose. We present these method's reliability and validity.

Case Report of Angiosarcoma on Scalp(2 Cases)

PURPOSE: Angiosarcoma of the scalp is unusual vascular tumor originating from endothelial cell. Angiosarcoma is an aggressive tumor with high propensity for both local recurrence and distant metastasis. We report 2 cases of angiosarcoma having poor prognosis recently. METHODS: Case 1 was a 67-year-old male patient. He visited the hospital with a 3x5cm sized discolored mass in forehead. It began at one month ago from coming to the hospital. Case 2 was a 64-year-old male patient. He visited for our hospital to remove a 4x5cm sized scalp mass. He had a pruritis on scalp from 9 months ago before coming to the hospital. Despite of the conservative treatments, the wound was not healed and advanced necrotic lesion with hemorrhage. RESULTS: Case 1 was diagnosed as an angiosarcoma. He underwent a radical operation 5 times. But the tumor expanded multiple area in dura & frontal area of the brain. The patient rejected the treatment any more. And he died one month later. Case 2 was diagnosed as an angiosarcoma and metastased to skull in MRI. He got a radical resection including cranium. Three months later, it recurred to ipsilateral Sternocleidomastoideus muscle. He got a additional operation & started radiotherapy. And now he is receiving chemotherapy, but the recurred lesion is expanding. CONCLUSION: Angiosarcoma is a highly malignant tumor. Especially it arises in vascularized area, it easily metastases. So it is best to treat angiosarcoma with surgery included wide margins. Despite the small lesion, we remember that angiosarcoma is a tumor that was consider to be metastases.

"Syndrome of the Sinking Skin-Flap" Secondary to the Ventriculoperitoneal Shunt after Craniectomy

The syndrome of the sinking skin flap was introduced to explain the phenomenon of neurological deterioration after decompressive craniectomy. A 37-year-old man was admitted with acute subdural hematoma and traumatic intraparenchymal hematoma. After decompressive craniectomy, the patient suffered from hydrocephalus for which a ventriculoperitoneal (V-P) shunt was inserted. Following this procedure, the depression of the skin flap became remarkable and his mentation was deteriorated. The patient recovered uneventfully after temporary elevating of valve pressure and cranioplasty. We present a patient who was successfully managed with elevation of valve pressure and cranioplasty for the syndrome of the sinking scalp flap with review of a pertinent literature.

Intracranial Invasion From Recurrent Angiosarcoma of The Scalp

Angiosarcoma of the brain, either primary or metastatic is extremely rare. Moreover, angiosarcoma metastasizing to the brain is also highly unlike to occur comparing with metastases to the other organs. Thus, an ideal treatment strategy has not been established. A 67-year-old man with past surgical history of a scalp angiosarcoma underwent surgical resection of intracranial invasion. Because of wide scalp flap excision andresultant poor vascularity of the scalp flap, additional radiation was not provided. Because adjuvant therapy is impossible due to poor scalp condition, more careful but ample resection of the primary lesion is essential to conduct initial operation.

Five Cases of Orbital Infarction Syndrome Caused by Compression of Surgical Scalp Flap / 대한뇌혈관외과학회지

Orbital infarction syndrome is a rare disorder resulting from ischemia of the intraocular and intraorbital structures due to hypoperfusion of the ophthalmic artery and its branches. The syndrome can occur with common carotid artery occlusion, orbital mucormycosis, giant cell arteritis and complications of surgery and manifests proptosis, ophthalmoplegia, and unilateral blindness. We recently experienced 5 cases of proptosis, ophthalmoplegia and unilateral blindness immediately after operation for 2 years. The cause of orbital infarction syndrome in these cases appeared to be the direct compression of orbit by the tightly retracted frontal scalp flap. We report and discuss possible mechanism with literature review.

A case of Orbital Infarction Syndrome Caused by Compression of Bulky Bicoronal Scalp Flap

PURPOSE: To report a case of orbital infarction syndrome induced by compression due to hard and bulky scalp flap. METHODS: Subject and METHODS: A 27-year-old female presented to our clinic, complaining of orbital pain, proptosis, ptosis, ophthalmoplegia and unilateral blindness, immediately after removal of cavernous hemangioma induced by the radiotherapy at 7 years earlier in right frontal lobe. Her scalp was hard and thick due to previous scar change and radiotherapy. Ophthalmologic examination demonstrated optic nerve injury, cranial nerve III, IV and VI palsy, diffuse retinal edema and cherry red spot in macula. Brain CT and MR angiography were done to evaluate the cause of orbital infarction. RESULTS: The cause of orbital infarction syndrome in this case appeared to be the compression of orbit by the hard and bulky scalp flap, and blindness was caused by the ischemia of intraorbital and intraocular structure.

A case of Orbital Infarction Syndrome Caused by Compression of Bulky Bicoronal Scalp Flap

PURPOSE: To report a case of orbital infarction syndrome induced by compression due to hard and bulky scalp flap. METHODS: Subject and METHODS: A 27-year-old female presented to our clinic, complaining of orbital pain, proptosis, ptosis, ophthalmoplegia and unilateral blindness, immediately after removal of cavernous hemangioma induced by the radiotherapy at 7 years earlier in right frontal lobe. Her scalp was hard and thick due to previous scar change and radiotherapy. Ophthalmologic examination demonstrated optic nerve injury, cranial nerve III, IV and VI palsy, diffuse retinal edema and cherry red spot in macula. Brain CT and MR angiography were done to evaluate the cause of orbital infarction. RESULTS: The cause of orbital infarction syndrome in this case appeared to be the compression of orbit by the hard and bulky scalp flap, and blindness was caused by the ischemia of intraorbital and intraocular structure.

The Role of Scalp Flap Retraction during Cerebral Aneurysm Surgery as a Potential Cause of Visual Deficits

OBJECTIVE: We recently reported six patients with unilateral visual loss that developed immediately after cerebral aneurysm surgery. This was found to be due to retinal ischemia. PATIENTS AND METHODS: To investigate whether or not this rare occurrence results from focal compression on the ipsilateral globe due to a scalp flap retraction, the authors checked changes of orbital pressure indirectly before and after the flap retraction in seven consecutive aneurysm patients and repeated the measurement in six other patients protected with an eye shield. In addition we have used an eye protector during aneurysm surgery over a next three-year period to determine whether or not an eye shield can prevent this problem. RESULTS: The authors confirmed elevation of indirect intraorbital pressure whenever the flap was retracted, but there was no pressure elevation in the study using an eye shield. In parallel we have not experienced any visual complications since this maneuver. CONCLUSIONS: We think that inadvertent pressure placed on the eyeball with a retracted scalp flap might provoke intraocular and/or retinal ischemia resulting in visual failure after intracranial aneurysm surgery in patients with any conditions that induce marginally ischemic retina.