Staged reconstructive treatment for extensive irregular cicatricial alopecia after burn

Abstract

For extensive irregular cicatricial alopecia after burn, effective and pleasing restoration of hair-bearing scalp remains challenging. In this article, the authors presented staged reconstructive treatment for extensive irregular cicatricial alopecia with the goal to achieve better and reliable results. A retrospective review of staged reconstructive treatment performed in 16 patients with extensive irregular cicatricial alopecia after burn was conducted. In stage 1, final flaps were designed at 1st. Tissue expanders were placed into the subgaleal plane and serially inflated with normal saline. In stage 2, scarring tissues were excised and the expanded hair-bearing flaps were advanced to the defect. Hair grafts were harvested from excessive hair-bearing scalps excised from the flaps and replanted. For patients with less satisfactory results, stage 3 was performed by hair transplantation. Cicatricial area, follicular unit density, survival rate of hair grafts, and patients' satisfaction were measured before and after each stage. Thirteen patients received 3-stage treatment, and 3 received 2-stage treatment. Significant improvements in aesthetics and patient satisfaction were achieved in all the patients. No flap necrosis, implant exposure or hematoma was observed. Ideal, aesthetic, and reliable results could be obtained using staged reconstructive treatment for patients with extensive irregular cicatricial alopecia after burn.

Figure 1

Staged reconstructive treatment. Stage 1: 3 expanders were serially inflated until adequate expansion (at least twice the surface area of alopecia) was attained (A). Stage 2: scarring tissues were excised and the expanded hair-bearing flaps were advanced to the defect (B). Hair grafts were harvested from excessive hair-bearing scalps excised from the flaps and replanted (C). For patients with less satisfactory results, hair transplantation was performed in stage 3 into hairline area, secondary scar and uncovered small alopecia areas (D).

Figure 2

Case 1: A 11-year-old boy presented with cicatricial alopecia in the vertex after burn. Preoperative views (A, B). Six months after stage 2 surgery views (C, D).

Figure 3

Case 2: A 26-year-old woman presented with cicatricial alopecia in the frontal area after burn. Preoperative views (A, B). Nine months after hairline restoration in stage 3 (C, D).