title: Reconstruction of hair-bearing areas of the head and face in patients with burns.
abstract: OBJECTIVE
  Tissue expansion is a well-documented surgical option. In patients with burns with defects in hair-bearing areas, the paucity of hair-bearing skin and donor-site problems presents a complicated issue. Herein we share our results in 10 patients with scalp and facial burns, requesting the reconstruction of hair-bearing areas and address important issues to bear in mind when undertaking this procedure.
  
  
  METHODS
  Ten patients with scalp, face, and neck burns were treated with tissue expanders for generating hair in hair-bearing areas, and were later treated with free or pedicle flaps. Expanders were placed in the temporal and/or the occipital or supraclavicular areas for 80 to 130 days depending on defect size. Tissue expansion was done slowly at weekly intervals; after completing the predicted expansion, a wait period of 3 to 4 weeks for the expanded tissue to rest was observed before the second operation. To reconstruct the scalp and facial hair-bearing areas, 2 free scalp flaps and 8 rotation flaps were prepared and transferred to the head, neck, and face in these patients.
  
  
  RESULTS
  Ten burn patients aged 20 to 35 years (mean = 28 years) (9 men and 1 woman) were treated with expanders followed by flaps. Defects ranged in size from 5 to 20 cm(2). Complications, mainly infection of the tissue-expander pocket, seroma formation, and partial flap loss (1 patient) were encountered.
  
  
  CONCLUSIONS
  Tissue expansion is a useful method for reconstruction of hair-bearing-area defects of the scalp, neck, or face, with good cosmetic results. Expansion is slightly more difficult in patients with burn scars and requires greater attention to technical details to prevent untoward complications. However, hair-bearing area reconstruction in burn and trauma patients done with expanded scalp skin has several major advantages: (1) The ability to close the donor site primarily, (2) expanded scalp skin has less hair follicles per square centimeter, (3) thinner skin provides a near perfect match to the facial skin, and (4) expanded skin can be transferred as a free or pedicle flap and can be even used to reconstruct multiple areas, such as eyebrow and cheek and mustache, simultaneously.
authors.affiliation: Department of Surgery, Iran University of Medical Sciences, Tehran, IR, Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Nazerani
authors.forename: Mohammad Hosein Kalantar
authors.initials: MH
authors.lastname: Motamedi
references.citation: Plast Reconstr Surg. 2000 Jun;105(7):2361-5
references.pmid: 10845287
references.citation: Ann Plast Surg. 1994 Feb;32(2):205-8
references.pmid: 8192373
references.citation: Arch Facial Plast Surg. 2007 Nov-Dec;9(6):392-9
references.pmid: 18025349
references.citation: Rev Stomatol Chir Maxillofac. 2007 Jun;108(3):234-7
references.pmid: 17532353
references.citation: J Plast Reconstr Aesthet Surg. 2009 Feb;62(2):216-20
references.pmid: 18054301
references.citation: Aesthetic Plast Surg. 1997 Nov-Dec;21(6):440-4
references.pmid: 9354610
references.citation: Burns. 2002 Nov;28(7):679-83
references.pmid: 12417165
references.citation: Ann Plast Surg. 2007 Jul;59(1):63-6
references.pmid: 17589263
references.citation: Ann Chir Plast Esthet. 2007 Dec;52(6):590-9
references.pmid: 17383065