Alopecia Excision and Repair

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Author: Taylor Dilday
Published:
Specialties: Plastic Surgery
Schools: University of Arkansas for Medical Sciences
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Basic Info
Contributors: Michael Golinko  and Kumar Patel
Removal of an approximately 5 cm congenital alopecia using an O to Z or
yin-yang flap method.
Advanced

Procedure

Patient is first marked with an ellipse around the area to be excised and two parabolic lines offset from each other and approximately the diameter of the area to be excised. 0.5% Lidocaine with epinephrine is then injected into the area, not only to anesthetize the area but also to help hydro-dissect in the loose areolar plane. The area of alopecia is then cut with a 15-blade scalpel and subsequently dissected away. The previously planned flaps are then cut with a 15-blade. Using a combination of blunt scissor technique and periosteal elevator #9 an area is dissected that is sufficient to mobilize the flaps into place. After sufficient mobilization and hemostasis is completed the flaps are stapled into place to help guide placement of the sutures. The tips of the flaps are left free and tucked under the opposing skin to help promote vascularization and prevent necrosis. 3-0 Vicryl buried galeal sutures are used and the skin and dermis is closed with 4-0 or 5-0 chromic suture in a matress fashion.

Indications

Defects in the parietotemporal regions of the scalp usually 5 cm or less. Congenital alopecia, Cicatricial alopecia, Alopecia areata, cosmesis.

Contraindications

Patient desire, recent systemic chemotherapy or radiation

Instrumentation

Setup

General anesthesia, head wrap exposing area of alopecia and a substantial margin. Shave the area immediately surrounding the defect. Mark the skin and prep with betadine. Inject Lidocaine and epinephrine and allow time for vasoconstriction

Preoperative Workup

History & Physical exam, CBC, Coagulation Profile, Metabolic Panel, Anesthesia ASA Categorization

Anatomy and Landmarks

Differentiate shaved skin from alopecia with absent follicles. Distinguish the dissection plane of loose areolar tissue between the periosteum and aponeurosis.

Advantages/Disadvantages

Maintains the natural whorl pattern of hair growth, but requires a substantial amount of intact tissue to be properly mobilized without creating excessive sheer and stress.

Complications/Risks

Bleeding, infection, seroma, scar formation from closure, necrosis at the tips of the flap

Disclosure of Conflicts

Bleeding, infection, seroma, scar formation from closure, necrosis at the tips of the flap

Acknowledgements

References

Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an Algorithmic approach. Plastic Reconstruction Surg. 2005;116:54. http://dx.doi.org/10.1097/01.prs.0000179188.25019.6c

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