Reconstruction of Hair-bearing Areas of the Head and Face in Patients With Burns

Aim: Tissue expansion is a well-documented surgical option. In patients with burns with defects in hair-bearing areas, the paucity of hair-bearing skin and donor-site problems presents a complicated issue. Herein we share our results in 10 patients with scalp and facial burns, requesting the reconstruction of hair-bearing areas and address important issues to bear in mind when undertaking this procedure. Materials and Methods: Ten patients with scalp, face, and neck burns were treated with tissue expanders for generating hair in hair-bearing areas, and were later treated with free or pedicle flaps. Expanders were placed in the temporal and/or the occipital or supraclavicular areas for 80 to 130 days depending on defect size. Tissue expansion was done slowly at weekly intervals; after completing the predicted expansion, a wait period of 3 to 4 weeks for the expanded tissue to rest was observed before the second operation. To reconstruct the scalp and facial hair-bearing areas, 2 free scalp flaps and 8 rotation flaps were prepared and transferred to the head, neck, and face in these patients. Results: Ten burn patients aged 20 to 35 years (mean = 28 years) (9 men and 1 woman) were treated with expanders followed by flaps. Defects ranged in size from 5 to 20 cm(2). Complications, mainly infection of the tissue-expander pocket, seroma formation, and partial flap loss (1 patient) were encountered. Conclusion: Tissue expansion is a useful method for reconstruction of hair-bearing-area defects of the scalp, neck, or face, with good cosmetic results. Expansion is slightly more difficult in patients with burn scars and requires greater attention to technical details to prevent untoward complications. However, hair-bearing area reconstruction in burn and trauma patients done with expanded scalp skin has several major advantages: (1) The ability to close the donor site primarily, (2) expanded scalp skin has less hair follicles per square centimeter, (3) thinner skin provides a near perfect match to the facial skin, and (4) expanded skin can be transferred as a free or pedicle flap and can be even used to reconstruct multiple areas, such as eyebrow and cheek and mustache, simultaneously.