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

ABSTRACT

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 26. 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.