HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Head and Neck Reconstruction

Fig. 4. ( A ) Early neck burn scar contracture status post 60% flame burn. ( B ) Intraoperative release of scar with minimal excision and platysma flap release. ( C ) Thick split-thickness skin grafts (STSG) to anterior and lateral neck releases.

methods of soft tissue coverage can be used based on the surrounding tissue deficits. These include temporoparietal fascial flaps with skin grafting, local tissue rearrangement, and subgaleal tissue expansion of the scalp ( Fig. 5 ). 38

Eyebrow reconstruction can be performed using a hair-bearing vascularized island flap, such as a temporal artery flap; composite graft; or hair trans- plantation using micrografts and minigrafts.

Scalp and Eyebrow Reconstruction

Recreation of the hair-bearing scalp in burn alope- cia is important in helping to restore the patient’s happiness and psyche. Smaller areas of alopecia can be corrected by serial excision and closure, as well as local tissue rearrangement, of the hair- bearing scalp. Large defects, however, may be reconstructed with hair transplantation when suffi- cient donor hair is available or with scalp expan- sion. The area of burn alopecia must be pliable and elastic to successfully accept hair grafts. Hair transplantation becomes an ideal choice for frontal and parietal burn alopecia to restore the anterior hairline. Tissue expansion can reconstruct a defect of up to 50% of the total surface area of the scalp with hair-bearing tissue of good density. The tissue expander has been described as being placed in both the subgaleal and supragaleal plane, and can be placed endoscopically to mini- mize the size of the incision ( Fig. 6 ). 39

Fig. 5. Right ear reconstruction with porous polyeth- ylene implant, temporoparietal fascia flap, and STSG.

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