Combination of Extended Paramedian Forehead Flap and Laser Hair Removal in the Reconstruction of Distal Nasal Defect

Depilation Before, During, or After Scalp Flap Expansion for Facial Reconstruction Using a Long-pulse 800-nm Diode Laser

Following facial reconstruction with a scalp flap, unwanted hair is a common esthetic problem. Reports on the safety, effectiveness, and differences in laser hair removal before, during, and after tissue expansion are lacking. The authors aimed to assess the efficacy of 800-nm diode laser hair removal before, during, and after flap expansion. A total of 366 patients who underwent long-pulse 800-nm diode laser hair removal from the scalp flap were included in this study. The patients were divided into 3 groups based on the timing of laser hair removal: nonexpansion, expander, and expanded. Participants received 1 to 8 treatment sessions at intervals of 25 to 30 days. To assess the effectiveness and differences in the treatment of each group, 2 independent observers compared the photographs and measured the reduction in the terminal hair count after treatment. The hair reduction rate was significantly higher with fewer treatment sessions when laser hair removal was performed during tissue expansion compared with after surgery or before surgery. Two cases of blisters were reported in the expanded group, all of which healed after aspiration and dressing changes. No severe adverse events were reported. Hair removal during or after scalp flap expansion is safe and effective when using an 800-nm diode laser. The depilation process during tissue expansion should be extremely accurate and well-designed. Depilation of the scalp before surgery is not recommended because of its low efficiency and long treatment duration.

A Larger Size of the Forehead Expander Can Reduce Donor Site Deformities and Acquire Better Outcomes After Forehead Tissue Expansion

BACKGROUND

Both reconstructive outcomes and donor site deformities should be considered in forehead expander selection for resurfacing facial skin defects. Cranial bone deformity as well as bone resorption always cannot be completely normalized after tissue expander extraction. This study aimed to investigate the correlation between the degree of frontal deformity, the reconstruction outcomes, and the expander size.

PATIENTS AND METHODS

Cases of forehead tissue expansion performed from 2011 to 2020 with 50/80 mL sized expanders and 150/200 mL expanders were retrospectively reviewed and separated into 2 groups. Demographic and clinical data were collected. Two plastic surgeons (Y.Z. and L.L.) who were not involved in the operation process compared the patient's preoperative photos with their final follow-up photos. The Fisher exact, 2-sample t tests, and the Wilcoxon rank-sum test were performed in this study.

RESULTS

Ultimately, 51 patients were included in the 50/80ml sized expander group, and 28 patients were included in the 150/200 mL expander group. Demographic data were collected and had no statistically significant differences between the 2 groups. There was no statistical difference in the frontal deformation rate between the 2 groups. The degree of frontal deformation was significantly different, and a large expander could significantly reduce the frontal deformation degree ( P < 0.05) and acquire a higher evaluation of the whole reconstruction outcomes ( P = 0.007).

CONCLUSIONS

The large-sized (150/200 mL) expander sited on the forehead was shown to have a slighter postoperative forehead change and better reconstruction effect. It is advisable to choose expanders with relatively larger sizes in the application of the forehead expand flap.

Hair follicle extraction combined with an expanded scalp flap for facial organ reconstruction

BACKGROUND

Use of scalp skin for facial organ reconstruction represents a mainstream procedure for organ reconstruction. In most cases, adequate amounts of skin can be obtained by using tissue expanders, but harvesting sufficient scalp tissue in patients with low hairlines is challenging. Hair follicular unit extraction (FUE) is one approach to resolve this problem. With FUE, hair follicles are removed from the scalp skin, which can then be prepared as a donor site to obtain sufficient amounts of hairless skin.

OBJECTIVES

To evaluate the safety and efficacy of FUE when combined with an expanded scalp flap for facial organ reconstruction.

MATERIAL AND METHODS

Patients with low hairlines requiring facial organ reconstruction were selected for this study. The area of skin extension and hair removal were determined prior to surgery, a process which was performed in three stages. Stage I consisted of hair follicle removal using the FUE technique at the donor site. Stage II involved expander implantation using water injections. In Stage III facial organ reconstruction was completed.

RESULTS

With the use of the FUE technique, hair follicles from the donor scalp were thoroughly removed and the donor scalp tissue was successfully expanded. Postoperatively, no evident scar formation at the reconstruction site or contracture of the expanded flap was observed. All patients were satisfied with the outcome of their reconstruction procedure.

CONCLUSION

FUE provides a means for hair follicle removal from the donor site and can be employed to achieve a safe and effective procedure for facial reconstruction in patients with low hairlines.

Optimal Timing of Laser Hair Removal in Expanded Forehead Flap in the Reconstruction of Facial Defects: During or After Tissue Expansion?

Background: The optimal timing of laser epilation with expanded forehead flaps in facial defect reconstruction remains undetermined. Objective: To compare the efficacy and safety of hair removal during or after flap expansion. Methods: This prospective exploratory study included 15 (11 women and 4 men, 16.47 ± 16.331 years of age) and 26 (19 women and 7 men, 10.69 ± 10.899 years of age) patients who underwent 755 nm long-pulsed alexandrite laser epilation during flap expansion and after surgery, respectively. Facial reconstruction was performed in these patients because of congenital melanin nevus, scar or port-wine stains. Evaluation included hair reduction rate, patient satisfaction, and adverse events. Results: The median number of laser sessions for hair removal during flap expansion was significantly lower than that after surgery (2.00 vs. 3.00, p < 0.01), and the hair reduction rate was also significantly higher during flap expansion (79.5% ± 21.93% vs. 68.3% ± 17.44%, p < 0.05). No severe adverse events were reported. Conclusion: Laser hair removal is safe and efficient when performed both during flap expansion period and after surgery, but its efficacy was significantly higher, and fewer sessions were required when performed during tissue expansion. Clinical trial registration information: ChiCTR1900026090.

The Transfer of Expanded Forehead Superthin Flap Without Frontalis and Less Hair Follicles Pedicled by Superficial Temporal Vessels

BACKGROUND

The expanded forehead flap pedicled with superficial temporal vessel(s) is a common method to treat facial scar deformity. However, local bulkiness and hair retention have limited the use of this flap.

METHODS

Five cadavers were used for anatomy to confirm the forehead "safety zone." A retrospective study was performed on 15 patients with facial scar deformity who were undergoing the expanded forehead superthin flap (without the expanded capsule, frontalis muscle, and with less hair follicles) pedicled with superficial temporal vessel(s) to transfer and repair the deformity.

RESULTS

Through cadaver anatomy, the range where the subdermal vascular network laid superficial to the hair follicle level was named the "safety zone," whose average distance between the bilateral penetrating points was 10.2 cm (8.7-11.6 cm). Fifteen patients with facial scar deformity were treated with the superthin flap technique. The trimming size of the safety zone flap was (6-10) × (12-20) cm. The median time of thinning the safety zone was 35 minutes (range, 25-40 minutes). All flaps healed well. The median residual ratio of the hair follicle was 39.8% (29.9%-50.5%). All patients were satisfied with the contour of the flap.

CONCLUSION

We firstly proposed a concept of forehead safety zone and used the superthin flap without the frontalis muscle and less hair follicles to treat facial scar deformity, and obtained an improved therapeutic effect. We think this is an appealing technique that can manifest facial concave and convex in the fine part, improve compliance of the flap, and reduce the times of laser hair removal.

Transfer Patterns and Clinical Applications of the Forehead Flaps Based on the Supratrochlear Artery and Supraorbital Artery

This study aimed to describe the application of transferring preexpanded forehead flaps based on the supratrochlear and supraorbital arteries in 3 patterns for facial reconstruction: Pattern I, interpolated flap; Pattern II, island flap; and Pattern III, propeller flap, which was subdivided into direct propeller flap (Pattern IIIa) and indirect propeller flap (Pattern IIIb). During the first stage, a tissue expander was inserted underneath the forehead. After sufficient inflation of the expander, a forehead flap based on the supratrochlear or supraorbital artery was elevated and transferred to reconstruct the facial defects. Three weeks after the surgery, pedicle division was performed, in which Pattern I and Pattern IIIb flaps were used. Twenty-four patients underwent facial reconstruction. Twenty-three flaps survived without any perfusion-related complications. Venous congestion developed in an island flap. All patients were followed up after surgery, ranging from 2 to 156 (mean, 19) months. The color and texture of the flap matched those of the adjacent skin. The patients and their families were satisfied with the final functional and esthetic outcomes. The forehead flap based on the supratrochlear and supraorbital arteries provides reliable coverage of facial defects. The conventional interpolated flap continues to be the most dependable. Single-stage reconstruction using the island flap and direct propeller flap is applicable to patients who decline the pedicle division procedure. The novel technique of using the indirect propeller flap is safe for cheek reconstruction with minimal donor-site morbidity and esthetically pleasing results.

Reconstruction of facial defects using a pre-expanded scalp flap: A description of the method used and outcomes of 43 patients

Background

A technique for reconstructing facial units with matching colour, similar texture and sufficient contour is ideal for patients with various facial defects. The current report aimed to present the experience of the authors in facial reconstruction using pre-expanded scalp flaps combined with laser hair removal.

Methods

From January 2014 to August 2021, 43 patients with different facial defects, such as post-burn scar and congenital nevus, were treated using this surgical technique that involved tissue expansion, scalp flap transfer and laser hair removal. Facial defects were artificially classified into three regions (forehead, n = 19; cheek, n = 15; and lips and chin, n = 9). Pedicle delaying and division were performed in patients who underwent reconstruction with pedicled flaps.

Results

Of the included patients, one presented with haematoma, one with infection and three had distal necrosis after expanded scalp flap transfer. The donor site was primarily closed in all patients. Further, all patients were successfully treated without major complications. The texture, colour and contour of the scalp flap after laser hair removal matched well with the surrounding skin tissues at 2–30-month follow-up.

Conclusion

Reconstruction using pre-expanded scalp flaps combined with laser hair removal is an effective and reliable option for facial reconstruction with excellent colour and texture match.

Reconstruction of Facial Multiunit Defects Using Expanded Scalp Flap with Laser Depilation in a Group of Predominantly Pediatric Patients

Background: The cervical or thoracic region is currently the main donor site for repair of facial multiunit defects (FMUDs); however, its extensive clinical utilization encompasses the need for flap prefabrication and microsurgical techniques. Objective: To illuminate the feasibility of treating FMUD with expanded scalp flaps and laser depilation. Methods: From 2016 to 2020, 17 patients with facial giant congenital melanocytic nevi (GCMN) underwent scalp expansion for FMUD reconstruction. A three-stage surgical treatment plan was attempted and laser depilation was scheduled during the expansion period and postrepair surgeries. Results: All the flaps survived successfully and were able to cover the entire facial defect. The average three-stage treatment time was 4.5 ± 1.3 months. The defect sites included the forehead, nose, cheek, temporal, and eye areas. The maximum defect area was 9 × 30 cm. The average number of laser treatments was 4.6 ± 2.9 times. The average treatment period was 26.8 months. Sixteen patients (94.1%) reported satisfactory outcome. Conclusion: Expanded scalp flap combined with laser depilation is feasible for FMUD repair and warrants further investigation. Clinical Trail Registration Information: Translational Medicine Ethics Review Committee, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine (SH9H-2021-T144-3).

Expanded scalp flap combined with laser hair removal to reconstruct facial defects around the hairline

BACKGROUND

Congenital and acquired facial lesions around the hairline can bring huge physical and psychological trauma to patients. At present, reconstruction of this area remains a challenge. In this study, we present an alternative technique to reconstruct the aesthetic units using an expanded scalp flap combined with laser hair removal.

METHODS

We retrospectively reviewed 25 cases of facial lesions around the hairline reconstructed with this surgical technique between May 2014 and May 2020. Expander was implanted under the scalp as designed before the operation. After the expander was fully expanded, the lesion was removed and the scalp flap was transferred. Laser hair removal was performed on the transplanted skin flap 2 weeks after flap transfer.

RESULTS

There were ten cases of postburn scar, nine cases of congenital nevus, four cases of traumatic scar, one case of haemangioma, and one case of nevus sebaceous. The median times of laser treatment was 3 (range, 1-8). The median follow-up time was 11 months, ranging from 1 to 27 months. The colour and texture of expanded flaps were similar to adjacent tissue in all cases. The direction of reserved hair in transferred flaps was consistent with the direction of hair in the recipient area or contralateral hair. There were no complications, such as infection, blistering, discolouration, and ulceration. All patients were satisfied with the appearance of the reconstructed hairline and the surgical outcomes.

CONCLUSIONS

The expanded scalp flap combined with laser hair removal is a feasible and effective technique to reconstruct both sides of the hairline simultaneously from a single donor site with a good colour match and a similar texture and thickness.