Reconstruction of large alopecia with old technique: V‐Y‐S plasty

Treatment of alopecia following burns, trauma or tumour surgery is challenging. Local flaps for small or medium sized defects and tissue expansion for larger defects is the common approach. Tissue expansion is a two‐stage procedure and the inflation process causes difficulty for patients. V‐Y‐S plasty is safe and one‐stage method of tissue reconstruction for scalp, face and other parts of the body. We performed this method safely for very large alopecia reconstructions in the scalp.     

THE USE OF TISSUE EXPANDERS IN SCALP ALOPECIA

This paper examines the role of tissue expansion, to correct scalp alopecia. The technique provides a means of producing sufficient hair bearing scalp to close defects which were previously not correctable. Reference is made to several surgical techniques which were found to be useful.     

婴儿先天性头皮全层缺损的修复

目的 探讨婴儿先天性头皮全层缺损的修复方法.方法 1996至2008年,对6例先天性头皮伞层缺损的患儿采用换药、皮瓣转移、扩张器扩张二期颅骨修补术等方法进行治疗.结果 6例头顶创面全部愈合.5例术后随访3个月至1年,2例有部分斑秃,2例瘢痕不明显.1例失访.结论 对缺损较小的头顶创面可换药愈合;对中等创面可用皮瓣修复;对巨大全层缺损创面先行换药,同时埋置扩张器扩张,二期行颅骨修补加扩张皮瓣转移术.     

Purse-string closure of scalp defects following tissue expansion: an effective aesthetic alternative.

Primary closure of scalp defects under tension can be complicated by scar widening and alopecia, and large defects usually require the use of local flaps, skin grafts or free flaps. Tissue expansion facilitates the use of local flaps to cover large defects, but multiple expanders and complex flaps with extensive incisions may cause significant scars and alopecia. We describe a purse-string closure of expanded scalp tissue following excision of a large congenital nevus sebaceous. This scalp reconstructive technique minimises iatrogenic scars and uses the predictable forces of scar contracture and skin re-draping to achieve a superior aesthetic result.     

Aesthetic Results of Treatment of Large Alopecia with Total Scalp Expansion

In the last 7 years, 18 patients with large alopecia (approximately one-third of hair-bearing scalp) were treated with 31 tissue expansion procedures. In the previous 44 patients, with various degrees of alopecia treated with conventional tissue expansion technique, the major complication rates were as high as reported in the relevant literature. The clinical experience gained with these cases led us to make some modifications in the surgical technique. We applied some simple surgical maneuvers and Z-plasties to the last 18 cases with large alopecia. The major complication rate of 3.2% observed in this study is comparable to the lower complication rates of 6–12% reported in the literature for different degrees of alopecia. We believe that these simple modifications and meticulous approach improve the results of conventional treatment of alopecia with tissue expansion and flap. In this paper, details of the insertion technique and reconstructive procedures and their relevance to the success rate of the aesthetic treatment of the large alopecia are discussed.     

Applications and complications of tissue expansion in pediatric patients

We have reviewed our experience with 61 tissue expansions in 49 pediatric patients. Indications for expansion included traumatic alopecia or soft tissue loss, myelomeningocele, congenital hairy nevi, burn scars, and other less common defects. The complication rate, necessitating interruption of expansion, was 25%. This occurred more frequently with scalp and burn reconstruction. Nevertheless, 86% of patients ultimately achieved good to excellent results.     

Tissue expansion: A simple technique for complex traumatic soft tissue defects

Post-traumatic soft tissue loss results in significant functional and esthetic morbidity. Reconstruction is often limited by shortage of soft tissues. Esthetic and functional restorations are possible by generation of well-matched autogenous sensate tissue by tissue expansion. Fifteen (nine females and six males) cases of large and complex soft tissue defects after trauma, age ranging from 7 to 43 years of age, were managed by tissue expansion over a period of 22 months. Indications were post-burn scars of the face (five), post-burn alopecia (three), avulsion injury scalp (one), massive abdominal wall defect (one), post-crush injury ankylosis of the right elbow (one), and post-burn contracture of the neck (three). Tissue expansion was well tolerated by all patients. Major complications seen were accidental implant deflation (6.6%) and partial implant exposure (6.6%). Minor complications were seen in 20% of the cases. Tissue expansion is slow and staged but a simple and safe reconstructive technique for managing large post-traumatic soft tissue loss with excellent results.     

Tissue expansion in the correction of burn alopecia: classification and methods of correction

Correction of burn alopecia using tissue expansion has recently gained acceptance. Yet, the technical approach to correction of this problem remains one of trial and error. Between January 1985 and December 1988, 102 children underwent placement of tissue expanders for correction of burn alopecia. Two hundred twenty-two expanders were placed during the 178 operative settings. Mean age was 9.1 +/- 4.3 years (range, 3-17 years). Forty-two patients previously underwent partial excisions or rotation of flaps to reduce or camouflage the initial burn alopecia. A review of our experience has dictated that proper classification of burn alopecia can influence operative planning and is essential for establishing guidelines for the correction of this problem. We have developed a classification scheme that addresses this problem. Patients are classified as type I, uniform alopecia; type II, segmental alopecia; type III, patchy alopecia; and type IV, total alopecia. The role of tissue expansion is reviewed in each group.     

扩张术治疗瘢痕性秃发的手术设计

目的:探讨头部扩张器修复瘢痕性秃发手术设计的重要性.方法:采用AutoCAD软件测量秃发面积,用一个或多个扩张器进行头皮扩张,利用扩张皮瓣修复瘢痕性秃发.结果:修复瘢痕性秃发18例,扩张皮瓣全部成活,头皮瓣毛发分布均匀,随访半年～1年,效果满意.结论:该方法的手术设计,是手术成败的关键,扩张术修复瘢痕性秃发并发症发生率低,毛发分布均匀,是目前治疗此类疾病的首选方法,值得推广.     

应用多个扩张器治疗头部大面积瘢痕性秃发

目的:探讨临床治疗头部大面积瘢痕性秃发的手术方法。方法:2006年2月到2012年10月,曾先后收治13例大面积的瘢痕性脱发患者,采用多个皮肤软组织扩张器进行头皮扩张,共埋置扩张器29个,容量300～500 ml,利用扩张皮瓣转移修复瘢痕性脱发。结果:术后随访3～10个月,扩张皮瓣成活良好,头皮瓣毛发分布均匀,手术效果较满意。结论:此手术方法皮瓣张力小,瘢痕不明显,毛发分布比较均匀,并发症发生率较低,可以作为大面积秃发病例治疗的较理想的方法。     

Scalp expansion in the treatment of cicatricial alopecia

The experiences of scalp expansion in the treatment of scarred alopecia in 16 cases with 21 tissue expanders are presented. In 13 cases, the defects were over 90cm2 in area, the largest one extending over half of the total hair-bearing scalp. In all cases, apart from one, the expanding procedures were completed. In one case the procedures were partially completed because of extrusion of the expander. Follow-up of 13 cases for 6-24 months showed good hair growth and appearances and 2 cases had 1.2-1.5 cm of widened scar at the distal edge of the expanded scalp due to undue tension. The advantages, disadvantages and complications are discussed.     

Planning of a local flap of expanded scalp for repair of alopecia cicatrisata

Tissue expansion of scalp opens a new way for the treatment of alopecia cicatrisata. From May 1986 to April 1988, 56 cases of alopecia cicatrisata and skull outcrop had been repaired by Chinese tissue expander in our department. All cases got good results. Of them, the area of alopecia was over 120 cm2 and the greatest one (320 cm2) consisting of two third of the total scalp in 21 cases. There were 49 cases repaired by one expansion and other 7 cases followed by a secondary expansion. The characteristics of the expanded scalp and the common types of local flap design had been discussed. It was applicable for all kinds of alopecia cicatrisata and both for children (over 3 yrs) and adults. The results of scalp expansion in children revealed superior than that in adults. We considered that the repairing of alopecia cicatrisata by scalp expansion had more advantages than other methods.     

Chirurgie des séquelles de brûlures du cuir chevelu

The sequelae of scalp burns may result in alopecia, more or less extended on a spontaneously unexpandable tissue. Treatment of such sequelae requires the alopecia plaques being replaced with local and regional hair flaps. Tissue expansion allows treating extended alopecia through large flaps which cannot be obtained by standard procedures. The techniques used are described; they often combine flaps of different types. Results are provided through clinical cases. Scalp expansion should strictly comply with rules and guidelines; it may induce complications. This technique may be reiterated.     

Aesthetic Reconstruction of Burn Alopecia by Using Expanded Hair-Bearing Scalp Flaps

Tissue expansion is one of the most important armamentaria for aesthetic scalp reconstruction after burn; however, the proper way to employ this technique for the scalp reconstruction usually presents a challenge to the plastic surgeon, especially in the case of a ``sideburn' scenario or a large lesion, as with, for example, hemiscalp alopecia. In this article, 11 patients, with different degrees of hair-bearing scalp loss as a result of burn, and including four patients with hemiscalp alopecia were successfully treated by using tissue expansion. The results show that tissue expansion is a simple, safe, and efficient technique for aesthetic scalp reconstruction. Versatile design of the expanded scalp flap can distribute the expanded hair-bearing scalp properly in the reconstructed recipient site.     

组织扩张术在瘢痕性秃发修复中的应用及疗效探讨

目的:探讨头皮扩张术治疗瘢痕性秃发的临床应用经验,强调头皮瓣设计的重要性。方法:1991年1月至2002年12月,应用头皮扩张术治疗瘢痕性秃发148例,手术选用100～500ml扩张器272个。头皮经扩张后采用如下方式进行修复:①单纯采用常规任意头皮瓣修复秃发区139例;②结合运用Orticochea多瓣法修复2例;③结合采用颞浅血管岛状头皮瓣转移修复鬓角3例、发际2例;④选择性将瘢痕性秃发区中存留的正常岛状生发头皮,形成以颞浅血管为蒂的岛状头皮瓣转移修复2例。结果:本组病例,修复秃发最大面积为310cm2,其中一典型病例,秃发面积达12cm×14cm,经一次扩张后修复全部秃发区。本组148例,一次性完全修复秃发135例,2例经接力扩张、6例经延期扩张后完全修复,剩余5例未完全修复,并发症发生率为17.6%。结论:头皮扩张术治疗大面积瘢痕性秃发有良好的整复效果,是大面积瘢痕性秃发较为理想的治疗方法。头皮扩张术结合多种类型头皮瓣设计的灵活运用可提高并改善瘢痕性秃发的修复效果。     

Treatment of cicatricial alopecia by the method of tissue expansion

The tissue extension method was applied in 13 patients with cicatricial alopecia of the scalp. Eighteen Soviet-made tissue expanders were used. Clinical experience showed that the sequelae of burns of the scalp attended by alopecia should be treated by tissue extension. The growth of hair can be restored on up to half of the scalp surface by expansion of the local tissues by their direct transfer and by additional formation of grafts for contour plastics. Plastics by expanded tissues is indicated for closure of naked bones of the vault of the skull.     

Application of tissue expansion in the treatment of post-burn skin contractures and alopecia

Summary A series of eleven patients who had fourteen tissue expanders inserted for post-burn scarring and post-burn alopecia is presented. The end results of tissue expansion have been satisfactory and there have been no complications. Three illustrative cases are presented.     

Tissue expansion techniques in burn reconstruction

The functional or aesthetic burn deformity invariably is the consequence of a local skin shortage. The ideal solution would be replacement with new normal tissues, and these can now be created via an adaptation of the natural phenomenon of tissue expansion. Representative examples of hypertrophic scars, skin grafts, and in particular burn alopecia are presented to demonstrate the superior improvements previously not possible with conventional techniques. The concept of tissue expansion deserves an important place in secondary burn reconstruction.     

皮肤软组织扩张术临床应用经验总结

目的:回顾总结皮肤软组织扩张术临床应用23年的经验,以进一步改善并提高该技术的治疗效果。方法:1984年11月至2007年6月对包括秃发、鬓角缺损、头皮撕脱伤、眼爆炸伤、下唇颏部瘢痕、鼻、耳再造等5000例次病例运用皮肤软组织扩张术进行修复治疗。通过基础研究和临床资料的回顾性分析,总结该技术应用的要点和注意事项,并进一步完善其应用中存在的缺陷。结果:术后效果证实该技术有较多的优点,对烧、创伤后畸形的修复,秃发、耳、鼻等器官再造,以及肿瘤切除后的修复,明显优于皮片移植及一般皮瓣治疗的效果。针对该技术存在周期较长并有较多并发症的缺点,23年来进行了逐步的完善,临床应用情况提示我们在具体应用时,应注意的关键问题是争取更多更好"的额外"皮肤软组织。在此基础上要注意完善设计思想,重视操作细节等。结论:掌握该技术的客观规律,重视整体设计思想,注重操作的细节,此技术的应用必将更为广泛并成为整形外科应用的先进技术。     

Tissue expansion in head and neck burn reconstruction

The advent of tissue expansion has provided a useful tool for the reconstructive burn surgeon. As with many new techniques, there was an initial wave of enthusiasm surrounding the introduction of tissue expansion to burn reconstruction in the 1980s. High complication rates and many dissatisfying results followed. After early widespread use of tissue expansion, the authors have settled on a more refined approach to the reconstruction of head, neck, and facial burns. Today, head and neck burn reconstruction is accomplished best with a combination of skin grafting, local flaps, and occasional free flaps in addition to tissue expansion. In carefully selected head and neck burn patients and in many burn alopecia patients, tissue expansion can provide excellent functional and aesthetic results, with minimal donor site morbidity.