Simple Method for Aesthetic Symmetrical Post Burn Reconstruction of the Temporal and Sideburn Subunits

Saleh, Mohamed

doi:10.21608/ejprs.2020.113501

Simple Method for Aesthetic Symmetrical Post Burn Reconstruction of the Temporal and Sideburn Subunits

Document Type : Original Article

Author

Mohamed Saleh

The Department of Plastic, Reconstruction, Maxillofacial Surgeries and Burn Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt

10.21608/ejprs.2020.113501

Abstract

Post burn scaring and reconstruction of the scalp is
common condition, which is challenging to plastic surgeons.
Which might lead to social deprivation and severe psychological
trauma, and patients always try to hide these areas with
scarf, hats, wigs, etc…. Although these attempts are common
and useful for the vertex and occipital region, temporo-parietal,
temporal, and sideburn are difficult to be camouflaged.
Different ways of reconstruction were used including:
Serial scar excision, follicular hair transplant, tissue expansion,
regional or remote tissue transfer with local or free flaps have
been described.
Although tissue expansion is the best and most popular
method for scalp reconstruction, the results might be unexpected
and displeasing. Searching on English speaking literature,
in all previous studies, success was attributed to the
expansion process in relation to the size, location of the
alopecia and donor area ignoring the importance of achieving
the exact or near normal pattern of hair line and symmetry of
the temporal, temporo-partial and side burn regions. This is
due to the absence of a simple method to guide surgeons while
planning and reconstructing this critical zone. In this study,
I am presenting a simple method utilizing the tissue expansion
for reconstruction of sideburn, temporal, and temporo-partial
alopecia to achieve satisfactory, symmetry and near normal
reconstruction.
This is a retrospective analysis of prospectively maintained
records of 29 patients, was conducted from February 2016 to
May 2018 in the Department of Plastic Surgery, Ain Shams
University, Cairo, Egypt. Twenty nine patients with scalp < br />burn alopecia of age 6 to 35 years were included in this study.
All patients were examined and assessment was done by
objective and subjective analysis.
The results shows that by using this simple method to
reconstruct temporal and lateral side burn area, it is proven
from the objective and subjective evaluation the aesthetic
outcome was satisfactory, symmetrical and standardized.

Keywords

Main Subjects

References

1- Zuker R.M.: The Use of Tissue Expansion in Pediatric
Scalp Burn Reconstruction. 1987. J. Burn Care Rehabilitation.
OvidTechnologies (Wolters Kluwer Health), 8
(2): 103-106, 1987.
2- Guzey S., Alhan D., S¸ahin I., Aykan A., Eski M. and
Nis¸ancı M.: Our experiences onthe reconstruction of
lateral scalp burn alopecia with tissue expanders. Burns.
May, 41 (3): 631-7, 2015.
3- Fan J., Wang J. and Nordström R.E.A.: Standardized
technique of transplanting micrografts in hair restoration
surgery: A practical approach. Dermatol. Surg., 23 (September
(9)): 829-33, 1997.
4- Giraldo F., Gonzales C. and Garnica I.: Sideburns reconstruction
with an expanded supraauricular trapezoidal
flap. Plast. Reconstr. Surg., 100 (July (1)): 257-61, 1997.
5- Oh S.J., Koh S.H., Lee J.W. and Jang Y.C.: Expanded
flap and hair follicle transplantation for reconstruction
of postburn scalp alopecia. J. Craniofac. Surg., 21 (November
(6)): 1737-40, 2010.
6- Felman G.: Post-thermal burn alopecia and its treatment
using extensive horizontal scalp reduction in combination
with a Juri flap. Plast. Reconstr. Surg., 93 (May (6)):
1268-73, 1994.
7- Barrera A.: The use of micrografts and minigrafts in the
aesthetic reconstruction of the face and scalp. Plast.
Reconstr. Surg., 112 (September (3)): 883-90, 2003.
8- Rosati P.: Extensive head burns corrected by scalp extension.
Dermatol. Surg., 21 (August (8)): 728-30, 1995.
9- Jincai F. and Peiying Y.: Aesthetic reconstruction of burn
alopecia by using expanded hair-bearing scalp flaps.
Aesth. Plast. Surg., 21 (November-December (6)): 440-
4, 1997.
10- Eski M. and S¸ahin I.: The use of tissue expander in the
head and neck region. Turk Plast. Surg., 15: 130-5, 2008.
11- Azzolini A., Riberti C. and Cavalca D.: Skin expansion
in head and neck reconstructive surgery. Plast. Reconstr.
Surg., 90 (November (5)): 799-807, 1992.
12- Biswas B.K., Pal S. and Bag S.: Clinical efficacy of an
indigenously developed tissue expander. Available from:
http:// www.ijesrt.com/issues%20pdf%20file/Archives-
2014/April-2014/86.pdf. Accessed March 2015, 2014.
13- Ahmad M., Mohmand H. and Surgeon H.R.: Role of tissue
expansion in hair restorative surgery. J. Pak. Assoc.
Dermatol., 23 (4): 423-427, 2013.
14- Epstein J.S.: Scalp reconstruction: The role of tissue
expansion. Hair Transpl Forum Intl., 16: 171-172, 2006.
15- Epstein J.S.: The role of tissue expansion in hair transplant
surgery: Presentation of two unique cases. Hair Transpl
Forum Intl., 12: 108-109, 2002.
16- McCauley R.L.: Tissue expansion reconstruction of the
scalp. Seminars Plast. Surg., 19: 143-152, 2005.
17- Yang Z., Fan J., Tian J., Liu L., Gan C., Chen W. and Yin
Z.: Aesthetic sideburn reconstruction with an expanded
reversed temporoparieto-occipital scalpflap. J. Craniofac.
Surg. Jul., 25 (4): 1168-70, 2014.
18- Guzey S., Alhan D., S¸ahin I., Aykan A., Eski M. and
Nis¸ancı M.: Our experiences onthe reconstruction of
lateral scalp burn alopecia with tissue expanders. Burns.
May, 41 (3): 631-7, 2014.
19- Jeong S.H., Koo S.H., Han S.K. and Kim W.K.: An
algorithmic approach for reconstruction of burn alopecia.
Ann. Plast. Surg., 65 (September (3)): 330-7, 2010.
Egypt, J. Plast. Reconstr. Surg., April 2020 377
20- Leedy J.E., Janis J.E. and Rohrich R.J.: Reconstruction
of acquired scalp defects: An algorithmic approach. Plast.
Reconstr. Surg., 116 (September (4)): 54e-72e, 2005.
21- Jincai F. and Peiying Y.: Aesthetic reconstruction of burn
alopecia by using expanded hair-bearing scalp flaps.
Aesth. Plast. Surg., 21 (November-December (6)): 440-
4, 1997.
22- Unger W.: Recipient area hair direction and angle in hair
transplanting. Dermatol. Surg., 30 (June (6)): 829-36,
2004.
23- Unger W.: The recipient area. In: Unger W.P., editor. Hair
transplantation. 3rd ed. New York: Dekker, p. 215-321,
1995.
24- Oh S.J., Koh S.H., Lee J.W. and Jang Y.C.: Expanded flap
and hair follicle transplantation for reconstruction of
postburn scalp alopecia. J. Craniofac. Surg., 21 (November
(6)): 1737-40, 2010.
25- Nordström R.E.: Stretch-back'' in scalp reductions for
male pattern baldness. Plast. Reconstr. Surg., 73 (March
(3)): 422-6, 1984.
26- Nordström R.E. and Devine J.W.: Scalp stretching with
a tissue expander for closure of scalp defects. Plast.
Reconstr. Surg., 75 (April (4)): 578-81, 1985.
27- Anderson R.D.: The expanded ''BAT'' flap for treatment
of male pattern baldness. Ann. Plast. Surg., 31 (November
(5)): 385-91, 1993.
28- Giraldo F., Gonzales C. and Garnica I.: Sideburns reconstruction
with an expanded supraauricular trapezoidal
flap. Plast. Reconstr. Surg., 100 (July (1)): 257-61, 1997.
29- Saleh M.A.1, Elshahat A., Emara M., Hussein H., Gould
L., Smith D. Jr. and Awad M.A.: Objective tools to analyze
the lower lateral cartilage in unilateral cleft lip nasal
deformities. J. Craniofac. Surg. Jul., 22 (4): 1435-9, 2011.
30- Elias D.L., Baird W.L. and Zubowicz V.N.: Applications
and complications of tissue expansion in pediatric patients.
J. Pediatr. Surg., 26: 15-21, 1991.
31- Gibstein L.A., Abramson D.L., Bartlett R.A., Orgill D.P.,
Upton J. and Mulliken J.B.: Tissue expansion in children:
A retrospective study of complications. Ann. Plast. Surg.,
38: 358-364, 1997.
32- Iconomou T.G., Michelow B.J. and Zuker R.M.: Tissue
expansion in the pediatric patient. Ann. Plast. Surg., 31:
134-140, 1993.
33- Friedman R.M., Ingram A.E. Jr., Rohrich R.J., et al.: Risk
factors for complications in pediatric tissue expansion.
Plast. Reconstr. Surg., 98: 1242-1246, 1996.
34- Cunha M.S., Nakamoto H.A., Herson M.R., Faes J.C.,
Gemperli R. and Ferreira M.C.: Tissue expander complications
in plastic surgery: A 10-year experience. Rev.
Hosp. Clin. Fac. Med. Sao. Paulo., 57: 93-97, 2002.
35- Pisarski G.P., Mertens D., Warden G.D. and Neale H.W.:
Tissue expander complications in the pediatric burn
patient. Plast. Reconstr. Surg., 102: 1008-1012, 1998.
36- Youm T., Margiotta M., Kasabian A. and Karp N.: Complications
of tissue expansion in a public hospital. Ann.
Plast. Surg., 42: 396-401; discussion 401-402, 1999.
37- Elshahat A.1: Management of burn deformities using
tissue expanders: A retrospective comparative analysis
between tissue expansion in limb and non-limb sites.
Burns, 37 (3): 490-4, 2011.