Eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap

Although various reconstructive procedures for the eyebrow have been reported, few have proved satisfactory for large-tissue defects. The authors describe two cases of eyebrow reconstruction with intermediate hair from the hairline of the forehead on the pedicled temporoparietal fascial flap (TPF flap) after malignant tumor resection. The first patient was a 24-year-old man with an adnexal carcinoma of the left eyebrow. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. The second patient was a 48-year-old woman with Bowen's disease of the left eyebrow. Tumor resection was performed on the frontal muscle with a 5-mm surgical margin. An intermediate hair flap was prepared at the hairline of the forehead in accordance with the defect. Both reconstructed eyebrows have maintained their shapes well. There have been several reports of the use of a TPF flap for eyebrow reconstruction, but none have used intermediate hair from the hairline. The authors are convinced that use of intermediate hair from the hairline of the forehead on the pedicled TPF flap is effective for reconstruction of the eyebrow and large defects extending to nonhairy subbrow skin.     

颞浅动脉岛状皮瓣在眉再造中的应用

目的 探讨颞浅动脉岛状皮瓣在眉再造中的应用。方法 2010年4月至2014年12月,共8例眉部分或全部缺损患者,采用颞浅动脉岛状皮瓣行眉部分或全眉再造。回顾性分析眉缺损情况、皮瓣成活情况、切口瘢痕和再造眉形态等。结果 眉缺损得到良好修复,再造眉外观满意,供区切口瘢痕不明显。结论 应用颞浅动脉岛状皮瓣修复眉部分或全部缺损效果较好,再造的眉毛比较浓密,尤其适合眉毛较为浓密的男性患者。     

Eyebrow reconstruction following burn injury

Facial burns represent between one-fourth and one-third of all burns. Absence of the eyebrows or distortions in their position alter the character of the face. Thus, eyebrow repair or reconstruction can be an important "finishing touch" in the overall reconstruction of a burned face. Generally, there are three ways to reconstruct the eyebrow: use of superficial temporal artery island flap; composite graft from scalp; and mini or micrografts from scalp. This report presents 20 patients reconstructed with the above techniques. Eleven patients (eight male and three female) with superficial temporal artery island flaps; seven patients (two male and five female) with composite grafts from scalp; and two patients (female) with minigrafts. The results suggest that superficial temporal artery island flaps were more suitable for males and composite graft for females who generally require thinner and less dense eyebrows. Our experience with minigrafts for burn alopecia has not been adequate. Here in this article, different methods of eyebrow reconstruction are presented with the greater emphasis on superficial temporal artery flap.     

Eyebrow Transplantation

BACKGROUND: Reconstruction of the eyebrow has historically been accomplished with temporal scalp pedicle flap formation or free composite scalp grafts. These two techniques may be associated with substantial morbidity and a false, overly dense eyebrow appearance. Hair transplantation of the eyebrows has been described with excellent results, but is relatively underreported in the literature. OBJECTIVE: To determine whether modern techniques of micrograft hair transplantation can suitably re-create an aesthetic eyebrow in a case of iatrogenic eyebrow alopecia. METHODS: A 33-year-old woman with iatrogenic eyebrow alopecia underwent four sessions of eyebrow micrograft hair transplantation to re-create both eyebrows. RESULTS: Suitable aesthetic eyebrows were re-created in a symmetric fashion with proper hair orientation. The process was time consuming and tedious, but highly effective. CONCLUSION: Eyebrow transplantation is a suitable alternative to pedicle flap formation and composite scalp grafting. It is a straightforward procedure that can be performed in the office under local anesthesia with minimal attendant morbidity. The result may be superior to that seen with more involved eyebrow replacement procedures.     

可调控眉毛密度的眉再造术同期治疗瘢痕性秃发的临床护理

目的:探索专项护理在眉再造同期治疗瘢痕性秃发术中的应用效果。方法:根据手术过程分两期进行专项临床护理。扩张器一期置入术后进行扩张器相关专项护理,严密监测扩张注水情况,密切观察扩张部位,防止扩张皮瓣坏死或感染;眉再造和瘢痕性秃发修复二期术后密切观察再造眉毛头皮条的颜色,避免静脉回流不畅发生。结果:本组12例患者进行了眉再造的全方位密切护理,岛状头皮瓣全部存活,头皮瘢痕全部修复,无一例皮瓣坏死。随访6~24个月,再造眉毛毛发密度与健侧非常接近,眉形自然逼真,手术效果满意。结论:在可调控眉毛密度的眉再造同期治疗瘢痕性秃发术中进行全方位护理是手术成功的重要保障。     

Total scalp replantation based on one artery and one vein

A successful replantation of a totally avulsed scalp, including both eyebrows, with only one arterial and one venous anastomosis to the superficial temporal vessels is described. Apart from a small partial skin necrosis of the right eyebrow, the entire transplant survived. Subsequently, the patient required only minor additional skin grafting, correction of scars with a skin expander, and reconstruction of the eyebrow with hair micrografts. Replantation of the total scalp based on two or more vessels has previously been recommended and reported elsewhere. In the present case, complete survival of the scalp on only one artery and one vein was demonstrated, indicating that replantation should be considered even if available vessels for anastomosis are minimal. © 1993 Wiley-Liss Inc.     

Reconstruction of orbital floor and maxilla with divided vascularised calvarial bone flap in one session.

We present four cases which underwent reconstruction of orbital floor and anterior maxillary wall with a vascularised bone flap following partial maxillectomy. After tumour resections, superficial temporal artery (STA) and vein based calvarial bone flaps from the outer tabula were prepared. Without disrupting the integrity of fascia and periosteum, the bone was separated into two segments in the same direction as the blood flow and one is 3 cm and the other 5 cm. The two bone segments were transferred as one single flap and one segment of the flap was used to reconstruct the orbital floor and the other for reconstruction of the anterior maxillary wall. Since two cases had large skin defects, lateral frontal skin to which the frontal branch of the STA supplies blood was incorporated into the flaps. Functional and aesthetic results were satisfactory at the end of 8-20 months follow-up. This technique allowed reconstruction of the orbital floor and anterior maxillary wall and even skin defects with a single pedicled flap in one session.     

针具打孔法单株毛发移植行眉毛美容性再造

目的:探索一种单株毛发移植修复眉毛永久性缺损的技术。方法:切取近后发际区域处含有完整毛发毛囊的条形头皮组织,借助于手术放大镜,将之分割,制备成单株毛发移植物待用。然后在预先设计的眉缺失区域内,以医用注射针具制备孔洞。继之,将这些待用之移植物按眉的自然走向植入到眉区预制的孔洞之中。结果:自2005年至2006年6月,共完成了52例89侧眉的美容性再造。所有患者一期手术均取得满意的美学修复效果。经术后6个月以上的临床随访见:再造的眉毛生长良好,成活率可达到98.5%。再造的眉形态走向较自然,较接近于正常的眉毛。从患者对术后再造眉的形态评价来看,非常满意者占84.6%;满意者占15.4%。结论:针具打孔法单株毛发移植技术手术方法简便快捷,出血少,手术野较清洁,再造的眉毛更加自然优美,是目前眉毛美容性再造较为理想的方法。     

颞筋膜蒂乳突发际皮瓣修复前额发际皮肤缺损

目的 探讨额颞部发际内外皮肤缺损的修复方法.方法 近十年间,应用耳后发际颞筋膜蒂岛状皮瓣转移修复前额颞部发际皮肤缺损5例.结果 皮瓣全部成活,5～7 d可见头发生长,发际内外界限清楚,额颞部形态佳.结论 应用耳后发际颞筋膜蒂岛状皮瓣转移修复颞额部发际皮肤缺损是一种可行的方法.     

Partial eyebrow reconstruction using subcutaneous pedicle flaps to preserve the natural hair direction

Five cases of partial eyebrow reconstruction using subcutaneous pedicle flaps from the ipsilateral eyebrow are presented. Proper use of this method will enable safe one-stage transfer of the skin and the eyebrow hair, preserving the natural hair direction and properties. It will also leave minimal scars and dog-ears. This method is especially suitable for the reconstruction of moderate- to small-sized eyebrow defects.     

Successful transfer of "free" microvascular superficial temporal artery flap with no obvious venous drainage and use of leeches for reducing venous congestion: case report

A case is presented of "free" flap based on the frontal branch of the left superficial temporal artery and its surrounding soft tissues, without any proper vein for anastomosis, successfully transferred for eyebrow reconstruction. One can argue that this flap was a Wolfe graft. It probably was not for two reasons. First, "hairy Wolfe grafts" are always composite grafts with a thickness of 3-4 mm, as the base of the hair follicles lies in the subcutaneous tissue. Second, the edges of the flap were not sutured to the surrounding skin. Therefore, vascularization is unlikely from the surrounding skin and there was constant, definite oozing from the edge of this flap.     

颞浅动脉岛状头皮瓣眉再造34例报告

我们应用颞浅动脉岛状头皮瓣行眉再造术34例取得了良好的临床效果。通过对34例病例的综合分析,分别就如何保证再造眉的良好形态,移植头皮瓣的成活,手术的方法,注意事项及设计的原则等问题进行了较为详尽的讨论。     

颞浅动脉岛状头皮瓣眉再造34例报告

我们应用颞浅动脉岛状头皮瓣行眉再造术３４例取得了良好的临床效果。通过对３４例病例的综合分析，分别就如何保证再造眉的良好形态，移植头皮瓣的成活，手术的方法，注意事项及设计的原则等问题进行了较为详尽的讨论。     

A trial on subcutaneous pedicle island flap for eyebrow reconstruction

Introduction

Severe burn is a common problem affecting victim's eyebrows. This study aims to assess the effectiveness, complications and patients’ satisfaction in two eyebrow reconstruction surgical methods. Up to now, many reconstruction methods, their specific advantages and complications have been introduced. This study compares a new method (subcutaneous pedicle island flap), which is scarcely discussed, with a standard method (superficial temporal artery island flap).

Method

This is a clinical trial conducted during 2003–2005 at the Al’ Zahra’ Hospital. Forty patients with eyebrow defect due to burn injuries were selected by convenience sampling. They were allocated to two groups randomly. The control group underwent a surgery for ‘superficial temporal artery island flap’ and the case group for ‘subcutaneous pedicle island flap’. Data were gathered using two questionnaires. The first one included demographic data, patient history and condition of the eyebrows prior to surgery, effectiveness of surgery and complications. The second was a smiley face visual scale for patient's satisfaction. Data analysis was done using SPSS software (version 12; SPSS Inc., Chicago, IL, USA).

Result

Findings showed that in the control group, 80% were female of a mean age of 22 years (SD = 6/30) and in the case group 75% were female, of a mean age of 21/80 years (SD = 8/28). Fisher's exact test showed a significant difference between the type of surgery and hair-growth direction (p = 0.003). In addition, Mann–Whitney U test showed a significant difference between the type of surgery and patient satisfaction (p = 0.002). Analysis showed that there is no significant difference between the type of surgery and bleeding, congestion, flap necrosis, temporary hair loss in flap and donor-site alopecia (p > 0.05). Surgeon's experience shows that surgery time and learning curve in the case group is lower than that in the control group.

Discussion

Subcutaneous pedicle island flap is an appropriate and easy method with good efficacy, lower complication and more reasonable and acceptable patient's satisfaction. Therefore, this method is recommended for burn patients with eyebrow defects.     

毛发单元移植行眉毛美容性修复再造

目的 探索应用毛发单元移植技术治疗各种原因所引起的眉毛永久性缺损。方法 切取后近发际区域处含有完整毛发毛囊的条形头皮组织，在手术放大镜下，将其分割，制备成毛发单元（每单元含1-3根毛发）即显微毛发移植物。然后，将这些植物按眉的自然走向植入到眉毛脱失区内预制的洞穴中。结果 自1998年4月至2000年2月，共完成了32例48侧眉的美容性再造。所有患者一期手术均取得满意的美容效果。经1年以上的临床随访再造眉毛生长良好。即使在瘢痕区域内，成活率也可达到95%，再造的眉形态走向较自然，接近于正常的眉毛。结论 毛发单元移植技术再造的眉毛与其它方式相比，手术方法简便，创伤小，更加自然，是目前眉毛美容性再造的理想方法。     

改良矩形皮瓣在修复眉内肿物切除术后创面中的疗效

目的 探讨改良矩形皮瓣在眉内肿物切除术后眉缺损修复中的应用效果。方法 选取2021年 1月-2022年6月在我院就诊的11例眉内肿物患者,行体表肿物切除术后根据缺损设计眉内改良矩形皮瓣修 复创面。术后随访分析手术效果,比较治疗前后双侧眉形对称、瘢痕程度、复发率和患者满意度。结果 11例 患者病理均显示为“色素痣”,手术后皮瓣一期存活率100.00%,皮瓣颜色、质地与周围组织接近,术后瘢 痕隐蔽,眉形、毛发浓密程度与健侧接近,外形美观,患者满意程度高。随访半年后,肿物无复发,瘢痕 无增生,皮瓣上眉毛生长良好无脱落。结论 改良矩形皮瓣修复眉内肿物切除术后创面疗效良好,不仅能 修复创面,还能很大程度地维持眉形,且术后瘢痕不明显。     

眉外伤清创缝合术中易被忽视的美学问题

目的：探讨眉外伤急诊清创缝合术中容易忽视的美学问题。方法：分析总结1992年1月至2010年12月,收治的235例眉外伤清创缝合创口愈合后发生眉形移位畸形95例,眉断裂不连接93例,眉部合并缺损47例,分别采用＂Z＂成形术或局部皮瓣转移术以及文眉修补矫正治疗。结果：通过＂Z＂成形术或局部皮瓣转移术治疗基本达到眉毛、眉形完整,对位良好者167例;有所改善者为36例;无明显改善者4例。经文眉修补治疗者28例,收到良好疗效。结论：眉外伤急诊清创缝合术中应注重眉的美学特点,对降低眉畸形的发生有着十分重要的意义。     

植皮区单株毛发移植修复眉毛缺损的观察

目的：观察单株毛发移植在植皮区的存活情况及再造眉毛的效果。方法：选择植皮区皮下软组织的厚度在3mm以上的患者,在枕后毛发安全供区（SDA）内局麻下切取一条带毛发的完整头皮。助手利用刀具分离出单株毛发,种植区肿胀麻醉后,术者用注射器针具按眉毛生长方向在植皮区上打孔,15～25孔／cm^2,将单株毛发种植于毛发缺损区。结果：2007～2009年间4例眉区植皮患者6只眉毛通过本方法治疗,术后随访9个月～2年,4只眉毛一次手术效果满意,2只眉毛需二次加密。所有毛发存活良好,毛发单次种植存活率接近90％,眉毛形态自然、美观。结论：在植皮区皮下软组织厚度3mm以上,密度15～25孔／cm^2的情况下,单株毛发移植在植皮区上的存活率接近90％,再造眉毛形态自然、美观。近似于真实眉毛效果。     

颞浅动脉额支岛状头皮瓣眉再造

对30例正常人颞浅动脉额支的走行进行测定,并应用颞浅动脉额支岛状皮瓣为1l例烧伤者再造眉19侧,取得满意效果。选用额部发际处柔软毛发,再造眉较自然,不仅适用于男性,亦可为女性及儿童解除缺眉之苦。     

Reconstruction of scalp and cranium defect utilizing latissimus dorsi musculocutaneous and serratus anterior muscle free flaps with interpositional anastomosis of T-shaped flap artery: case report

The use of a combination musculocutaneous free flap, consisting of a latissimus dorsi flap and a serratus anterior flap, for reconstruction of a large scalp and cranium defect is described. The recipient artery, the superficial temporal artery (STA), was anastomosed to the flap artery, without sacrificing blood flow, by means of a special technique: forming the end of the flap artery into a T shape and interposing it between the two stumps of the transected STA, because the STA was crucial for tissue adjacent to the defect. The flap vein was anastomosed to the external jugular vein with a vein graft. The extensive defect was immediately closed with sutures, and there were no remarkable complications.