Tissue expansion in operated cases of transposition flap of scalp for correction of donor site alopecia and patient’s satisfaction

Background: Scalp defects managed by local transposition flaps with donor site alopecia are aesthetically not acceptable to patients. Scalp expansion with tissue expanders is needed for proper correction of this deformity.Methods: Authors retrospectively reviewed all cases of post traumatic and post burn scalp defects that were managed initially by local transposition flap and later by scalp expansion by tissue expanders at our institute over a period of 5 years and conducted an outcome survey. Authors’ institutional protocol in such patients and results of the review are presented.Results: Twenty-eight patients were included in the study. Eight patients had post traumatic and 20 cases had post electric burn scalp defect. The mean age of patients was 28.92±8.26 years. Thirty-eight tissue expanders of various sizes (200-600 ml) were used in 28 patients. The mean follow-up time was 9.07±1.92 months. Major complication rate in present study was 2.63%. Results of outcome survey revealed more than 90% patients were satisfied after third surgery.Conclusions: Scalp transposition flap donor site alopecia can be easily corrected by tissue expansion. The complications are not severe and can be managed easily. It should be offered to all such types of patients, as it leads to proper social rehabilitation and satisfaction among these groups of patients.

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Reconstruction of scalp with local axial flaps

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20203575 ◽

2020 ◽

Vol 6 (9) ◽

pp. 1692

Author(s):

Saket Srivastava ◽

Pradeep Gupta

Keyword(s):

Tissue Expansion ◽

Free Tissue Transfer ◽

Healing Time ◽

Surrounding Tissue ◽

Surgical Reconstruction ◽

Local Flaps ◽

Transposition Flap ◽

Scalp Reconstruction ◽

Scalp Defects ◽

Scalp Defect

Background: The scalp is a unique part of the human body and various etiological factors, such as tumour extirpation, infection, burns, or trauma, can lead to scalp defects. Primary closure, skin grafting, local flaps, tissue expansion or free tissue transfer are modalities available for scalp reconstruction. In this article, the authors share their institutional experience using various local flaps concerning the size, location, depth of defect and the quality of surrounding tissue.Methods: From September 2017 to January 2020, 54 patients underwent scalp reconstruction with local flaps for a defect size of 5 to 150 cm2 in the department of plastic surgery, SMS medical college, Jaipur. Patients were identified by age, sex, cause of the scalp defect; the location, size, and depth of the defect; condition of surrounding tissue and the type of reconstruction done.Results: The most common cause of scalp defect was excision of malignant tumour (50%). Thirty patients had a large sized defect (40-90 cm2) and 28 patients had 90-150 cm2 defects. Surgical reconstruction was done using local flaps, transposition flap was the most used in 36 patients (66.7%) followed by rotation advancement flap in 11 patients (20.4%). The recovery was relatively quick. Minor complications happened in 5 patients (9.3%) that were managed conservatively.Conclusions: In the present era of microsurgical reconstruction, local options as axial flaps provide a simpler and safer method of scalp reconstruction. A carefully planned scalp flap gives healthy, robust, hair-bearing tissue coverage and requires a shorter healing time for the patients.

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Reconstruction of Post-Electrical Burn Scalp Defect with Exposed Bone: A Case Report

10.31487/j.jscr.2020.02.09 ◽

2020 ◽

pp. 1-3

Author(s):

Rafaela Pais Serras ◽

Maria Manuel Mendes ◽

Pedro Martins ◽

Rafaela Pais Serras ◽

Ruben Coelho

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Transposition Flap ◽

Below The Knee ◽

Scalp Defects ◽

Reconstructive Ladder ◽

Degree Burn ◽

Scalp Defect ◽

Exposed Bone ◽

Electrical Burns

Introduction: Electrical burns are potentially devastating injuries and most often occur at the workplace. Scalp defects following electrical burns are a rare occurrence and usually present as a reconstructive challenge. Case Presentation: Male, 31 years old, suffered a high voltage electrical burn at work that resulted in a scalp defect with exposed bone and a third degree burn in the left leg and foot complicated by a compartment syndrome, which needed an emergent fasciotomy and later an amputation below the knee. The scalp defect was covered by a local transposition flap and a skin graft. At 3 months post-operatively flap survived completely with no necrosis or other complications. A satisfactory cosmesis and preservation of scalp contour were achieved. Conclusion: Reconstructive ladder must be respected in reconstruction of these rare and complex defects. Local transposition flaps, if available, are often an ideal choice for scalp reconstruction in that the adjacent tissue is of similar quality to the original defect tissue with a long-term durability, contour preservation, minimal donor site morbidity and an acceptable cosmesis.

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Reconstruction of a secondary scalp defect using the crane principle and a split-thickness skin graft

BMC Surgery ◽

10.1186/s12893-021-01056-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yi Lu ◽

Ke-Chung Chang ◽

Che-Ning Chang ◽

Dun-Hao Chang

Keyword(s):

Skin Graft ◽

Subcutaneous Tissue ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Salvage Procedure ◽

Primary Defect ◽

Scalp Defects ◽

Thickness Skin ◽

Scalp Defect ◽

Secondary Defect

Abstract Background Scalp reconstruction is a common challenge for surgeons, and there are many different treatment choices. The “crane principle” is a technique that temporarily transfers a scalp flap to the defect to deposit subcutaneous tissue. The flap is then returned to its original location, leaving behind a layer of soft tissue that is used to nourish a skin graft. Decades ago, it was commonly used for forehead scalp defects, but this useful technique has been seldom reported on in recent years due to the improvement of microsurgical techniques. Previous reports mainly used the crane principle for the primary defects, and here we present a case with its coincidental application to deal with a complication of a secondary defect. Case report We present a case of a 75-year-old female patient with a temporoparietal scalp squamous cell carcinoma (SCC). After tumor excision, the primary defect was reconstructed using a transposition flap and the donor site was covered by a split-thickness skin graft (STSG). Postoperatively, the occipital skin graft was partially lost resulting in skull bone exposure. For this secondary defect, we applied the crane principle to the previously rotated flap as a salvage procedure and skin grafting to the original tumor location covered by a viable galea fascia in 1.5 months. Both the flap and skin graft healed uneventfully. Conclusions Currently, the crane principle is a little-used technique because of the familiarity of microsurgery. Nevertheless, the concept is still useful in selected cases, especially for the management of previous flap complications.

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A simple external tissue expansion technique based on viscoelastic properties of skin to attain direct closure of a large scalp defect: A case report

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.173137 ◽

2015 ◽

Vol 48 (03) ◽

pp. 309-312

Author(s):

Bandikatla Venkata Ratnam

Keyword(s):

Case Report ◽

Viscoelastic Properties ◽

Tissue Expansion ◽

Defect Coverage ◽

Mechanical Device ◽

Direct Closure ◽

Patient Profile ◽

Scalp Defects ◽

Expansion Technique ◽

Scalp Defect

ABSTRACT Background: Direct closure of large scalp defects is not an easy task. Complicated flap designs or staged surgeries over a period of 6 months are often required. A case of a large scalp defect that was closed directly in 3 months by applying a simple external tissue expansion technique is presented in this report. Patient Profile: A 28-year-old male patient presented with a painful swelling of about 13 cm × 14 cm, on frontoparietal scalp. A biopsy done elsewhere reported it to be a neurofibroma. He sought tumour excision and scalp defect coverage by hair-bearing scalp in a period of less than 5 months. Materials and Methods: The tumour was excised and the adjacent scalp was gradually expanded with the help of an external fixator. The patient had immediate pain relief after excision. The goal of repairing scalp defect and replacing it with hairy scalp was achieved in 3 months. Conclusion: The mechanical device required for this technique is relatively easily accessible. It is not difficult to achieve desirable outcomes, and the same can be applied to large wounds on other areas.

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SCALP RECONSTRUCTION: EXPERIENCE OF 50 PATIENTS AT TERTIARY LEVEL CENTRE IN INDIA

10.36106/ijsr/2324795 ◽

2021 ◽

pp. 62-65

Author(s):

RK Jain ◽

Nitesh Lamoria

Keyword(s):

Tissue Expansion ◽

Malignant Tumour ◽

The Body ◽

Surgical Reconstruction ◽

Detailed Knowledge ◽

Body Contour ◽

Scalp Reconstruction ◽

Scalp Defects ◽

Aesthetic Appearance ◽

Scalp Defect

NTRODUCTION Scalp possesses unique anatomical & aesthetic features and occupies the most prominent part of the body. Scalp defects are neither easy to look at or to reconstruct. The factors influencing decision making in the repair of scalp defects are their size, depth and location. Various reconstructive options include primary closure, skin grafts, trephination, local tissue aps with or without tissue expansion, regional myocutaneous ap and microvascular free ap. A successful reconstruction surgery must result in less morbidity, good aesthetic appearance, decreased hospitalization time, preserving the hairline without violating the body contour. METHODS Study was conducted in the Department of Plastic and Reconstructive Surgery, SMS Hospital, Jaipur, India. A sample size of 50 patients From September 2019 to march 2021, requiring scalp reconstruction procedures was taken. All the details of the patient that were relevant to the study were collected during the preoperative, intraoperative and postoperative periods and during follow which was later analyzed. RESULTS The most common cause of scalp defect was excision of malignant tumour (40%). Surgical reconstruction using rotational and transposition ap was done in 37 patients (74%).In 5 cases (10%) reconstruction done using free ap. The recovery was relatively quick in all cases. In 2 cases (4%) partial ap necrosis occur which was managed conservatively. CONCLUSION An aesthetically pleasing scalp reconstruction requires a precise preoperative planning with detailed knowledge of scalp anatomy and blood supply. The wide armamentarium of techniques for reconstruction allows the plastic surgeon to give a much pleasing nal result and his creativity on the table added to all these elements together can give a satisfactory result for the patient.

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TISSUE EXPANSION

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.04.3008 ◽

2010 ◽

Vol 17 (04) ◽

pp. 611-615

Author(s):

MUHAMMAD AHMAD

Keyword(s):

Tissue Expander ◽

Major Complication ◽

Tissue Expansion ◽

Inclusion Criteria ◽

Flap Surgery ◽

Exclusion Criteria ◽

Acute Injuries ◽

Fill Volume ◽

Safe Technique ◽

The Mean

Objective: To share the experience of tissue expansion. Study Design: Descriptive. Duration: June 2005 to May 2009. Setting: Aesthetic Plastic Surgery, Rawalpindi. Inclusion Criteria: Patients of all ages and sex undergoing tissue expansion. Exclusion Criteria: Patients having acute injuries, burns and defects which were closed primarily. Patients undergoing primarily flap surgery. Materials and Methods: The shape and size of the tissue expander was chosen according to the deformity and expected wound geometry. All the surgerieswere performed under general anaesthesia. Drains were removed after 48 – 72 hours. Slightly filled (20 – 50ml) tissue expanders were used. Tissue expansion was started after 7 – 12 days and were filled twice weekly. Results: Total 19 patients (12 males & 7 females) were included in the study. The mean age in males was 32.9 years (range 13 – 44 years) and 21.1 years (range 19 – 36 years) in females. The differentdeformities included contractures 31.6%, Postburn scar 21.1%, hypertrophic scar 15.8% followed by congenital naevus 10.5%. The fill volume ranged from a 140 ml to 480 ml over a period of 8–13 weeks. No major complication was noted. Slight loss of distal flap occurred in 2 patients. No infection/rupture of tissue expander was seen. Conclusion: Tissue expansion is a safe technique for reconstruction of defects, with an obvious advantage of the availability of the adjacent skin.

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Cerebriform congenital melanocytic nevus of scalp and its management using tissue expansion

Journal of Skin and Sexually Transmitted Diseases ◽

10.25259/jsstd_68_2021 ◽

2021 ◽

Vol 0 ◽

pp. 1-3

Author(s):

Shruti Patel ◽

Naveen Kumar

Keyword(s):

Tissue Expansion ◽

Surgical Excision ◽

Melanocytic Nevus ◽

Congenital Melanocytic Nevus ◽

Parietal Region ◽

Psychological Consequences ◽

Tissue Expanders ◽

Pigmented Lesion ◽

Scalp Defect ◽

Variable Surface

Congenital melanocytic nevi are benign proliferations of cutaneous nevomelanocytes. Usually, they manifest at birth or become apparent within the first few years of life. The nevi show variable surface morphology (papular, rugose, verrucous, or cerebriform). Congenital melanocytic nevus showing cerebriform morphology is a rarity. Early diagnosis and surgical excision are usually recommended in congenital melanocytic nevus to prevent the future risk of malignant transformation which is higher in larger lesions, especially in giant forms (>20 cm in size). An excision of the lesion also helps to avoid the social and psychological consequences arising out of significant cosmetic deformity. We report a 21-year-old patient who presented with a cerebriform congenital melanocytic nevus measuring 10 cm × 7 cm × 2 cm in the right parietal region. Early-onset, pigmented lesion with a cerebriform surface, and the histopathology features of congenital melanocytic nevus were the points that favored the diagnosis of cerebriform congenital melanocytic nevus in our patient. He was treated with excision of the lesion and defect coverage with tissue expansion in two stages. Two rectangular tissue expanders were placed beneath the galea aponeurotica (one with a capacity of 300 cc in the left parietal region and another with 500 cc in the occipital region). Both the expanders were inflated twice to their capacity. Second stage surgery was performed after about 3 months in which the tissue expanders were removed and the pre-expanded scalp skin was used to drape the scalp defect that resulted from the excision of the lesion. An excision and a two staged reconstruction of the scalp using tissue expanders, may ensure a good aesthetic outcome in the management of intermediate to large sized congenital melanocytic nevus.

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Early outcome after the use of the triceps fascia flap in interposition elbow arthroplasty: a novel method in the treatment of post-traumatic elbow stiffness

SICOT-J ◽

10.1051/sicotj/2020006 ◽

2020 ◽

Vol 6 ◽

pp. 8

Author(s):

Emmanuel C. Iyidobi ◽

Cajetan U. Nwadinigwe ◽

Remigus T. Ekwunife ◽

Udo E. Anyaehie ◽

Lasebikan A. Omolade ◽

...

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Fascia Lata ◽

Elbow Stiffness ◽

Native Bone ◽

Elbow Arthroplasty ◽

Post Traumatic ◽

The Mean ◽

Triceps Fascia ◽

Fascia Flap

Background: Post-traumatic elbow stiffness (PTES) results in severe interference with the activities of daily living (ADL), affecting mainly young people. Total elbow arthroplasty (TEA) is relatively contraindicated in the young patient and arthrodesis is poorly tolerated. Interposition elbow arthroplasty (IEA) improves the range of motion (ROM) buying time for future reconstructive surgery. While the fascia lata remains the most common material used in IEA, the triceps fascia is a native vascularized tissue, and it does not require a separate incision to harvest. To our knowledge, there are no published studies on the use of this technique of IEA. Method: Sixteen patients with post-traumatic elbow stiffness had IEA with the triceps fascia between January 2009 and January 2017. The ROM was assessed pre-operatively and post-operatively at the 6th and the 24th week. The researchers also evaluated the functional outcome with the Mayo Elbow Performance Score (MEPS) at the 24th week. The data were analysed with the software IBM SPSS Version 20. Results: Nine males and seven females had IEA with the triceps fascia. The mean age of the subjects was 22.8 years (SD = 6.39). The median duration of the stiffness was eight months (range: 2–168 months). Fall was the most frequent cause of post-traumatic elbow stiffness, and the non-dominant side was more frequently involved. Fourteen patients had an intervention at the native bone setters before presentation to the hospital. The mean elbow ROM increased from 16.4° pre-operatively to 97.2° at the 24th week (p < 0.001), while the mean MEPS improved from 42.5° pre-operatively to 81.2° post-operatively (p < 0.001). Conclusion: The triceps fascia flap provides an excellent alternative to the fascia lata for IEA without the complications of the donor site morbidity.

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Outcome of scalp reconstruction in a teaching hospital

Bangladesh Medical Journal Khulna ◽

10.3329/bmjk.v48i1-2.27089 ◽

2016 ◽

Vol 48 (1-2) ◽

pp. 3-6

Author(s):

Md Tariqul Islam ◽

SK Nishat Abdullah ◽

Md Mehedi Newaz ◽

Mizanur Rahman ◽

Md Ashikur Rahman

Keyword(s):

Skin Graft ◽

Donor Site ◽

Graft Loss ◽

Tissue Expansion ◽

College Hospital ◽

Transposition Flap ◽

Rotation Flap ◽

Medical College ◽

Scalp Reconstruction ◽

Free Flap Surgery

An area of loss of scalp could be covered by various methods including local flap, distant flaps, skin graft, free flap surgery or tissue expansion. Each method has some disadvantages, such as postoperative alopecia or donor site morbidities. The study was conducted in the Department of Burn and Plastic Surgery, Khulna Medical College Hospital from July 2011 to June 2015. Scalp reconstruction was performed on 16 patients who sustained scalp loss from RTA, surgery for cancer, burn injuries and machinery injury. The size of the wound ranged from 6 cm2 to 320 cm2. Transposition flap, rotation flap, removal of osteomyelitic bone and skin grafts were done. Among 16 cases, 3 cases (18.75%) were skin grafted, 6 cases (37.5%) were reconstructed with transposition flaps, 5 cases (31.25%) were reconstructed with rotation flap and 2 cases (12.5%) were reconstructed with skin graft after removal of osteomyelitic outer table of skull bone. The postoperative complications seen in this series includes partial graft loss in 2 cases (skin graft), marginal necrosis in 1 case (transposition flap) and alopecia in 11 cases (in skin graft and transposition flap). There was no alopecia in reconstruction with rotation flap. Rotation flaps brings the best outcome in terms of durability and aesthetic acceptability where it is applicable in comparison to other procedure.Bang Med J (Khulna) 2015; 48 : 3-6

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The Safety and Antimicrobial Properties of Stabilized Hypochlorous Acid in Acetic Acid Buffer for the Treatment of Acute Wounds—a Human Pilot Study and In Vitro Data

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211015656 ◽

2021 ◽

pp. 153473462110156

Author(s):

Ewa A. Burian ◽

Lubna Sabah ◽

Klaus Kirketerp-Møller ◽

Elin Ibstedt ◽

Magnus M. Fazli ◽

...

Keyword(s):

Pilot Study ◽

Hypochlorous Acid ◽

Treatment Time ◽

Donor Site ◽

Antimicrobial Properties ◽

Prolonged Treatment ◽

Wound Irrigation ◽

The Mean ◽

And Performance

Acute wounds may require cleansing to reduce the risk of infection. Stabilized hypochlorous acid in acetic buffer (HOCl + buffer) is a novel wound irrigation solution with antimicrobial properties. We performed a first-in-man, prospective, open-label pilot study to document preliminary safety and performance in the treatment of acute wounds. The study enrolled 12 subjects scheduled for a split-skin graft transplantation, where the donor site was used as a model of an acute wound. The treatment time was 75 s, given on 6 occasions. A total of 7 adverse events were regarded as related to the treatment; all registered as pain during the procedure for 2 subjects. One subject had a wound infection at the donor site. The mean colony-forming unit (CFU) decreased by 41% after the treatment, and the mean epithelialization was 96% on both days 14 (standard deviation [SD] 8%) and 21 (SD 10%). The study provides preliminary support for the safety, well-tolerance, and efficacy of HOCl + buffer for acute wounds. The pain was frequent although resolved quickly. Excellent wound healing and satisfying antimicrobial properties were observed. A subsequent in vitro biofilm study also indicated good antimicrobial activity against Pseudomonas aeruginosa with a 96% mean reduction of CFU, when used for a treatment duration of 15 min ( P < .0001), and a 50% decrease for Staphylococcus aureus ( P = .1010). Future larger studies are needed to evaluate the safety and performance of HOCl + buffer in acute wounds, including the promising antimicrobial effect by prolonged treatment on bacterial biofilms.

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