Expansion cutanée dans les alopécies cicatricielles du cuir chevelu: 18 cas

[Complications of head and neck expansion: Acting on modifiable factors. A study of 98 prothesis]

BACKGROUND

Tissue expansion is a key tool in the therapeutic arsenal that is proposed for repairing soft tissue losses of the head and neck. This technique, however interesting it may be, is not without its risks. The aim of this work is to identify the different steps of this procedure, determine the complications risk factors inherent to each step of the expansion and propose recommendations to improve functional and aesthetic results.

PATIENTS AND METHODS

We carried out a retrospective study on tissue expansion of the head and neck over a period of 10 years extending from January 2009 to December 2018, with at least one year follow-up for each patient. Our study counted 63 patients with the placement of 98 prostheses. We considered the various variables involved in the expansion process in order to determine those that increase the risk of complications.

RESULTS

In our series we counted 66.3 % of complications and 22.4 % of failures. We found that a young age increased the risk of skin suffering and that smoking increased the risk of hematoma occurrence. Neck expansion was found to be the riskiest site of expansion followed by the scalp that increased the risk of exposure (especially the parietal section of the scalp). The face is considered as an interesting site for expansion. We found that the use of multiple expanders is an attractive alternative to iterative expansions and to the choice of large expanders.

CONCLUSION

Tissue expansion of the head and neck requires careful planning that takes into account each step of the process.

Contemporary Management of Alopecia: A Systematic Review and Meta-analysis for Surgeons

BACKGROUND

The decision of surgical approach for hair restoration often involves evaluation of the type of alopecia; however, the impact of surgical hair restoration from existing techniques in specific population subsets has not been comprehensively investigated.

OBJECTIVES

The authors sought to systematically review the literature on micrografts, minigrafts, mini-micrografts, tissue grafts, tissue flaps and expanders, as well as evaluate graft survival and satisfaction within specific populations in a meta-analysis.

METHODS

PubMed and Scopus literature searches between 1980 and 2018 yielded 57 articles for systematic review and 34 articles for meta-analysis. Study design, mean patient age and gender, patient alopecia type, surgical hair restoration technique, number of treatment areas, mean follow-up, graft survival rate and satisfaction rate were extracted from each study, and a meta-analysis was performed.

RESULTS

The pooled rates of graft survival were 84.98% (95% CI 78.90-91.06) using micrografts and 93.11% (95% CI 91.93-94.29) using micrografts and minigrafts in nonscarring alopecia patients, as well as 88.66% (95% CI 80.12-97.20) using micrografts and 86.25% (95% CI 74.00-98.50) using micrografts and minigrafts in scarring alopecia patients. The pooled rates of satisfaction were 89.70% (95% CI 82.64-96.76) using micrografts and 97.00% (95% CI 92.48-100.0) using micrografts and minigrafts in nonscarring alopecia patients, as well as 97.80% (95% CI 94.59-100.0) using micrografts and 88.70% (95% CI 66.49-100.0) using micrografts and minigrafts in scarring alopecia patients. Dot plots depict rates of graft survival rate from micrografts and satisfaction from micrografts and minigrafts.

CONCLUSION

Surgical hair restoration for nonscarring and scarring alopecia yields high graft survival and satisfaction rates.

LEVEL OF EVIDENCE III

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[Complications of head and neck skin expansion]

INTRODUCTION

Skin expansion is a good solution for the reconstruction of head and neck defects. We assessed the complications of cervico-facial skin expansion technique to draft recommendations so as to minimize risks.

METHODS

We made a retrospective study from 1990 to 2005. Complications were analyzed according to age, sex, etiology, area to reconstruct, location of the expander, expander volume and number, simultaneous single or repeated technique, type of expander, duration of expansion, and type of flap used for reconstruction.

RESULTS

One hundred and thirty-nine tissue expanders were placed in 114 patients. The rate of complications was 60.4%. Age was not a risk factor (P=0.21; Fisher's exact test). The early complications were not related to the expander volume (P=0.32; Fisher's exact test). Infection was the most frequent complication (51.3%). Hypertrophic or large scars, retraction, or cording accounted for 32.4% of sequels. A rate of 6.5% of total and 6.5% of partial failure were recorded. Infection was the cause of 77.8% of total or partial failure.

DISCUSSION

The complications of head and neck soft tissue expansion are often minor. The rate of reconstruction failure remains acceptable.