Scalp reconstruction is a procedure to repair scalp defects caused due to trauma, burns, cancerous and non-cancerous lesion removal, congenital abnormalities and poor wound healing from a previous surgery.
Reconstruction of the scalp can be performed based on the size, aesthetics and depth of the wound by any of the following techniques:
- Primary closure is a suitable technique used for closure of small scalp defects (less than 3 cm in diameter). The surrounding skin is brought together and sutured. This may not be appropriate for larger defects as the skin and underlying scalp tissue (galea) are not elastic.
- Vacuum-assisted closure is used for moderate-to-large defects of the scalp. The device works by applying uniform pressure to the wound area, which improves blood supply, reduces bacterial counts and encourages the development of granulation tissue (blood vessels and connective tissue that form during the healing process on the wound).
- Replantation is the treatment of choice for avulsion injuries that are most often caused by hair entrapment in machinery. Microsurgical techniques are used to replant the avulsed tissue and join the torn blood vessels.
- Skin grafting: A healthy piece of skin with the underlying musculature and blood vessels can be harvested and transplanted to close the wound.
- Local flaps are suitable for closure of moderate-sized scalp defects. This technique is usually indicated for secondary reconstruction after excision of primary skin grafts or scars. It involves moving the surrounding tissue into the defect.
- Serial excision is best used for treatment of bald spots less than 50 cm2 caused by burns or any other trauma. The technique involves removing non-hair-bearing tissue across several months.
- Scalp extender surgery involves the implantation of a stretchable device. For best results the scalp scar should have good flexibility.
- Hair transplants are effective in areas having sufficient blood supply and subcutaneous tissue.
Selection of the method depends upon several factors such as the depth and location of the wound and the amount of tissue damage around the defect.