Scarred scalp reconstruction with a rectangular expander

Novel Scalp Flap Elevation With Balloon Trocar Dissection Device

BACKGROUND

Balloon trocar devices have been utilized in several surgical cases to reach a difficult-to-access location, achieve hemostasis, and obtain safe, efficient surgery.

OBJECTIVE

Highlight the balloon trocar dissection device in a novel technique of scalp flap elevation for tissue expander placement.

METHODS

The pocket for the tissue expander was determined at the scalp. A 2 cm vertical incision was made. A 12 mm balloon trocar is then introduced and insufflated. Through the trocar, endoscopic light is then inserted. Scalp flap elevation was performed with the device. The exact location of the pocket was seen with the lumination of endoscopic light.

RESULTS

The balloon trocar dissection device provides easy scalp flap elevation and bleeding control. With the help of endoscopic light, the pocket for the expander was created precisely.

CONCLUSION

The balloon trocar device is simple, effective, low-cost equipment for tissue expander placement in the scalp.

The Treatment of Linear and Narrow Scar after Craniotomy Using the Follicular Unit Excision

Background  The scar alopecia after cranioplasty (SAC) may decrease the patient's quality of life. We have treated SAC using follicular unit extraction (FUE). The aim of this study was to discuss that efficacy of FUE and how much hair follicular unit (FU) should be transplanted intraoperatively for the treatment of SAC.

Methods  We treated 10 patients (4 men and 6 women) who had SAC using FUE.

Results  The average age, alopecia size, and intraoperative hair density on the graft area were 29.8 ± 12.1 years, 29.8 ± 44.5 cm ² , and 34.6 ± 11.8 FU/cm ² , respectively. One year postoperatively, the average hair survival rate on the graft area was 66.3 ± 6.1%. Hair appearance was rated as good in six, fair in three, and poor in one. Among patients whose 1-year postoperative hair density was ≥ 20 FU/cm ² , five of six patients achieved good results. However, among patients whose 1-year postoperative hair density was < 20 FU/cm ² , all four patients achieved fair or poor results. The postoperative hair density was significantly higher in patients whose 1-year postoperative hair density was ≥ 20 FU/cm ² than in patients whose 1-year postoperative hair density was < 20 FU/cm ² . The rate of achieving fair or poor results was significantly higher if the postoperative hair density was < 20 FU/cm ² than if it was ≥ 20 FU/cm ² ( p  = 0.047).

Conclusions  FU excision is useful for the treatment of scar alopecia after craniotomy. Our results suggest that the 1-year postoperative hair density should exceed 20 FU/cm ² to achieve good outcomes.

Extended Scalp Expansion for Larger Defects During Staged Cranioplasty

BACKGROUND

Secondary cranioplasty is often required following trauma, infection, radiation, or oncologic care, but is complicated by soft-tissue deficits with limited regional options. Scalp tissue expanders can provide hair-bearing, vascularized tissue for tension-free closure yielding optimal aesthetic results. However, the upper limit of safe scalp expansion has not been explored. This study sought to evaluate the efficacy of extended scalp tissue expansion for challenging cranioplasties in a consecutive series.

METHODS

Patients who underwent scalp tissue expansion before cranioplasty were retrospectively identified from a single institution between the years 2017 and 2020. Patient demographics, tissue expansion characteristics, and complications during expansion and after cranioplasty were collected.

RESULTS

Six patients were identified who underwent staged scalp expansion for cranioplasty; 5 were male (83.3%) with a mean age of 43.8 ± 12.5 years. Indications for cranioplasty included 2 epilepsy-related procedures, 1 oligodendroglioma, 2 infectious processes, and 1 traumatic incident. A single expander was used in 5 cases, whereas 2 were used in the remaining case. The average expander fill volume was 434.3 ± 115 ccs with a mean expansion time of 3.3 ± 1.4 months. Expander infection occurred in 1 case and expander exposure in another, but adequate scalp expansion was still achieved in both. Successful closure over cranioplasty was obtained in 5 cases (83.3%); 1 patient ultimately required free flap reconstruction for soft-tissue coverage.

CONCLUSIONS

In cases of extended scalp defects, scalp tissue expansion remains the preferred method for recruiting large quantities of like tissue before implant cranioplasty.