Bilateral temporoparietal flaps in the treatment of male baldness

This article presents the bilateral temporoparietal flap method for treating frontal baldness. In this procedure symmetrical flaps 2.0–3.0 cm wide are moved from the hairy temporoparietal region to the frontal part of the head and joined in the middle. The surgery can be done simply with no delays and under local anesthesia. The hair on both flaps grows upward, but it covers the top of the head to give it a thick feeling.     

A new scalp flap for baldness

The technique and results of a new scalp flap that solves frontal baldness are described. As a bipediculate flap it offers a great amount of hair when advanced and has a low rate of complications. This kind of flap has been used by us for four years in 36 patients in the age group between 20 and 60 years. The results obtained with the flap have been very satisfactory.     

An alternative flap in the treatment of baldness

This is a report of a new flap for baldness which gives a full frontal hairline with the hair pointing forward. The flap donor area is grafted with the patient's scalp skin and homografts, avoiding a split skin donor site. In addition, the flap donor area after closure is well hidden.     

Hair growth following scalp microvascular flap transfer for baldness due to burn injury.

A female patient, 8 years of age, presented with baldness of the right scalp following deep scalds from boiling soup landing on the head, neck, and chest. The depth of the burn was severe enough to cause baldness. She was primarily advised to wear a wig to address the problem of baldness on one side. Surgery was planned to use uninjured scalp skin to offer hairy skin coverage of the bald site. A left scalp skin flap (2.5 by 7 cm) based on the superficial temporal artery and vein was transferred to the bald area, with microvascular anastomosis to the superficial temporal vessels on the right side. There was complete survival of the flap with uneventful recovery and satisfactory growth of hair. Hair growth from the flap was comparatively thicker than from the rest of the scalp. This microvascular flap has produced sufficient hair to cover the entire area of the baldness and the patient does not need to wear a wig.     

Microsurgical free temporoparietal flaps in surgery for male pattern baldness

A method known as the microsurgical free temporoparietal flap transfer for restoring the anterior hairline has been described. With the use of this technique, the grafted hair should have a natural hair direction, and the grafted hair exhibits a normal appearance after surgery to correct baldness.     

保留耳前鬓角形态并预防脱发的颞颊部除皱术

目的:介绍一种保留耳前鬓角形态并且预防术后脱发的颞颊部除皱术式。方法:颞部切口位于发际缘后方5cm左右并与鼻唇沟平行,耳前切口位于鬓角后缘。颞部于颞浅筋膜深面剥离至发际缘,切开颞浅筋膜于其浅面剥离至眼轮匝肌浅面。耳前于表浅肌肉腱膜浅面剥离至咬肌前缘。垂直于颞部切口向外上方悬吊颞浅筋膜,垂直于鼻唇沟向外上方悬吊腮腺浅面的表浅肌肉腱膜。结果:2008年以来应用该法治疗颞颊部面部老化患者24例,效果满意,未发生严重并发症。结论:该术式保留了耳前鬓角的自然形态,术后切口瘢痕隐蔽,无明显脱发,避免了重要神经、血管的损伤。     

Single-stage surgical treatment of frontal baldness

Since Lamont first presented his hairflap procedure over 15 years ago for correction of frontal baldness, a number of changes and improvements in the technique have taken place. The author presents a one-stage temporo-parieto-occipital flap procedure that has developed from the work of Lamont and Juri.     

A new scalp flap for baldness

The technique and results of a new scalp flap that solves frontal baldness are described. As a bipediculate flap it offers a great amount of hair when advanced and has a low rate of complications. This kind of flap has been used by us for four years in 36 patients in the age group between 20 and 60 years. The results obtained with the flap have been very satisfactory.     

美容扩张器在头皮良性肿瘤切除中的应用探讨

目的:探讨美容扩张器在头皮良性肿瘤切除中的应用价值。方法:根据美容水扩张器的原理,先后对收治的15例头皮良性肿瘤患者实施了一期埋入美容扩张器,6～8周后施行二期肿瘤切除+成形术。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,手术效果满意。结论:应用美容扩张器行头皮肿瘤切除,皮瓣成活良好,头皮瓣毛发分布均匀,手术效果满意。     

应用重复扩张术修复大面积瘢痕性秃发

目的：探讨重复扩张术修复大面积瘢痕性秃发的临床应用方法。方法：对7例大面积瘢痕性秃发的患者，进行2～3次的头皮重复扩张，每次扩张间隔时间1年左右，分次修复剩余瘢痕。结果：7例患者，均获得满意结果，与单次性扩张相比，无额外的并发症发生。重复扩张的皮瓣具有良好的伸展性和存活能力，随访0．5～1年，见头发虽较未扩张部位稀疏，但生长良好。结论：重复扩张术是修复大面积瘢痕性秃发的安全有效的方法，可获得良好结果。     

Endoscopic-assisted harvest of the temporoparietal fascial flap

Elevation of the temporoparietal fascial flap by conventional T or Y incisions in the temporal region frequently leaves conspicuous scarring, hair thinning, or baldness. To avoid such undesirable effects, endoscopic-assisted harvest of the temporoparietal fascial flap was performed in 9 patients with microtia. Through two horizontal incisions in the temporal region, the temporoparietal fascia was dissected, and the flap was harvested using bipolar scissors and coagulating shears. Flaps were dissected and harvested successfully without any complications in 7 patients, although extra incisions were required to facilitate coagulation in 2 patients. The authors introduce this harvesting technique and describe some representative cases. Using endoscopic guidance, this is a versatile, safe procedure with minimal morbidity, and is applicable to other reconstructive procedures that require a temporoparietal fascial flap, including the free flap.     

192例头颈部游离组织瓣移植的临床分析

目的 对192例的204块头颈吻合血管的游离组织移植作回顾性分析。方法 1999年5月-2001年3月由同一术者完成手术192例，分析其一般情况、临床病理诊断、缺损情况、所采用组织瓣的类型、组织瓣成活情况及术后并发症的发生情况，并分析有可能影响皮瓣成活的各种因素。结果 前臂皮瓣（83块）、腓骨瓣（81块）和腹直肌肌皮瓣（32块）为采用最多的3种游离组织瓣，占全部组织瓣的96.1%；成功率为98.5%，术后11例发生血栓，其中8例经抢救成活，3例失败；57例受区和供区出现并发症，但大我数并发症均较轻，没有造成严重的后果；吸烟、饮酒、放疗和年龄（高龄和儿童）等均非影响组织瓣移植成功的重要因素。结论 头颈部游离组织瓣移植修复安全可靠，明显优于传统的带蒂组织瓣，值得进一步推广和应用。     

Treatment of male pattern baldness with a one-stage flap

A 1-stage correction of baldness is described, using a vertical preauricular or retroauricular flap, and employing local anesthesia rather than general anesthesia.     

Reconstructive implications of adipofascial flaps in limb defects

Today a great variety of techniques are available to reconstruct any limb defect. Because of this, one should select an appropriate method and not use a particular technique for all defects. We found the adipofascial flap to be suitable and advantageous for many defects. This paper describes the anatomical basis, planning, technique, and variations of the adipofascial flap. The majority of these flaps are defect-based hinge flaps incorporating perforators in the base, and hence they are perforator-perfused flaps. A skeletonized perforator flap has increased malleability and achieves more distal reach. These can also be used as a free flap. An adipofascial flap has several advantages, e.g., minimal donor site morbidity, greater mobility, and more refined reconstruction, and it provides a good gliding surface for the tendons and avoids hair bearing skin transfer. A series of 32 cases performed over 5 years is presented.     

Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction

BACKGROUND: Although the anterolateral thigh flap has been extensively used for head and neck reconstruction in Asia, reported variations of vascular anatomy seem confusing and may have contributed to the unpopularity of this flap in the United States. The purposes of this study are to classify the vascular anatomy and to assess the suitability of this flap for head and neck reconstruction in a Western population. METHODS: Seventy-two consecutive anterolateral thigh flaps for head and neck reconstruction was retrospectively reviewed. RESULTS: The number of cutaneous perforators for the anterolateral thigh flap ranged from one to three. On the basis of their location and origin, a simple classification system is introduced to assist flap dissection. Of the 72 thighs explored, 68 flaps (94%) were raised successfully. CONCLUSIONS: The vascular anatomy of the flap follows predictable patterns. The anterolateral thigh flap is well suited for head and neck reconstruction in Westerners.     

改良胸大肌肌皮瓣在晚期头颈肿瘤手术中的应用

目的探讨一种保留胸大肌功能的改良胸大肌肌皮瓣的制作方法。方法根据胸大肌肌皮瓣的解剖学特点设计皮岛，将胸大肌肌皮瓣的血管蒂完全解剖出来而不携带肌肉，使肌皮瓣成为名副其实的岛状瓣，从而完整保留了胸大肌的锁骨部分以及胸大肌外侧大部分肌纤维。结果2002至2005年采用该方法制做改良胸大肌肌皮瓣29例，其中20例修复口内缺损，4例修复颈部缺损。3例修复腮腺区缺损，2例修复下咽部缺损。术后皮瓣全部成活，随访6个月至2年，所有患者术后进食、吞咽功能良好，语言功能大多恢复良好。结论改良胸大肌肌皮瓣应用于头颈外科克服了传统的胸大肌肌皮瓣的缺点，提高了肌皮瓣血供的可靠性，最大程度地保留了胸大肌的功能和胸部的外形。     

Baldness surgery

Redistribution from hair-rich to hair-poor areas is the fundamental principle of baldness surgery. Success of hair transplantation is based on the fact that transplanted hair follicles will behave as they did in their original area and continue to grow. Three basic techniques are employed: scalp flaps, scalp reductions and hair grafts. Each technique has undergone considerable refinements answering to initial wrong results and criticisms. The typical doll-hair tufted effect of old macro-grafts has disappeared with micro-graft shift. The unaesthetic cheese-like Hippocratic crown donor defect aspect ended when harvesting a long strip of occipital hair bearing scalp. The posteriorly directed hair growth has disappeared by using superiorly based flaps. Respective indications and tension-free closure ensure that the incidence of necrosis is low. Limited results of old scalp reductions have decreased by testing preoperative laxity of the scalp and using extensive undermining of the scalp. The future may release on medical treatment avoiding dihydrotestosterone to act on genetically predisposed follicles avoiding miniaturization of the hair and baldness development. However, when baldness has appeared, as the hair follicle's culture is not actually effective, the state of art is still to plan a surgical strategy using successive stages of this large panel of techniques to reach a natural effect with the best hair orientation and density.     

激光脱毛在头皮扩张穿支皮瓣制备过程中的应用

目的 探讨在头皮扩张皮瓣的扩张期进行激光脱毛的安全性及疗效。方法 2014年1月到2015年4月,选择22例应用头皮扩张穿支皮瓣修复面部软组织缺损的患者,在注水扩张期使用半导体激光进行脱毛治疗。结果 22例患者均完成了扩张器置入-注水扩张-激光脱毛-转移修复的序贯疗程。转移修复术后皮瓣均存活,19例皮瓣表面无明显粗长毛发,2例皮瓣仍有少量毛发残留,1例发际边缘小面积秃发。1例患者在激光治疗后出现水疱,1周后自愈,未观察到长期并发症。结论 激光脱毛技术可安全有效地应用于头皮扩张穿支皮瓣的制备过程,改善皮瓣修复术后患者面部外观,提高手术满意率。     

Internal mammary artery perforator flap for head and neck reconstruction

Background: The internal mammary artery perforator (IMAP) flap is a useful modification of the classic deltopectoral flap that has a number of important roles in head and neck reconstruction. Methods and results: In this report, we describe the technique used to plan and raise the flap and demonstrate its use in three different clinical scenarios. Results and conclusions: The IMAP flap is a pedicled fasciocutaneous flap that is based on single or multiple internal mammary artery perforators. As such, it provides thin pliable tissue with a wide arc of rotation that is suitable for cutaneous, pharyngeal and tracheostomal reconstruction. Moreover, the flap is well‐vascularised, reliable and the donor site can be closed primarily.     

Hair transplantation to the eyebrow, eyelashes, and other parts of the body

Since its earliest applications, hair transplantation has been used for treating not only the scalp in pattern baldness but also other parts of the body, commencing with eyebrow reconstruction. The earliest micrografts were applied to the eyebrow more than 30 years before their application to the scalp became the standard of care. Today hair transplantation is applied to a number of other areas. The principle behind transplanting these areas is the same-once transplanted, the hairs continue to grow because of the phenomenon of donor dominance. This article reviews the role and technique of hair transplantation to the eyebrows and eyelids, chest, beard and moustache, and pubic escutcheon.