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At least 217 records · Page 12Linked to original sources
PubMed2002

The distribution of follicular units in the Chinese scalp: implications for reconstruction of natural-appearing hairlines in Orientals.

BACKGROUND: Follicular transplantation using hair in its naturally occurring groups, called follicular units (FUs), has become the most popular technique in hair restoration surgery. Recently follicular transplantation was performed with a qualitative and quantitative concept to achieve the best clinical result. The characteristics and distribution of FUs are well studied in Caucasians and widely applied in hair transplantation surgery. OBJECTIVE: In order to understand the normal distribution of FUs in the Chinese scalp, we counted the number of hairs and FUs in normal Chinese scalp to provide general information for surgical planning and design in bald Chinese patients. METHODS: A total of 50 normal and 50 bald Chinese adults were enrolled to count the hairs on their scalp. One hundred bald patients receiving hairline reconstruction were also prospectively quantitatively evaluated. RESULTS: In normal Chinese scalp, an average 71.78 FUs/cm(2) and 137.08 hairs/cm(2) were calculated with a follicular density of 1.91 hairs/FU. Two-hair FUs are the predominate group (50.29%). In bald patients, an average of 68.07 FUs/cm(2) was found, which was less than that of the occipital scalp in normal nonbald patients. In reconstruction of the frontal hairline, a total of 700-1000 FUs were implanted with an average density of 30 FUs/cm(2). CONCLUSION: We found the average number of FUs (0.72 FU/mm(2)) was less than that in Caucasian patients (1 FU/mm(2)). The average density of 30 FUs/cm(2) implanted was suitable to reconstruct a natural frontal hairline in bald Chinese patients, which can achieve about 40% of normal hair density. Our results could provide the hair surgeon with general information about hair distribution on the Chinese scalp for surgical planning and design in their patients.

Adult↗
PubMedDate not supplied

Dysplastic nevi of the scalp and forehead in children.

To determine if there is a significant difference in the relative frequency and degree of atypia of sporadic dysplastic nevi from the scalp, face, and neck area in children as compared with nevi from the rest of the body, we reviewed 99 consecutive biopsy specimens of melanocytic nevi from the scalp, face, and neck areas in children less than 18 years of age and compared them with 95 consecutive cases of nevi from other areas of the body in children of the same age. Large numbers of the nevi biopsied from the scalp (13 of 31; 41.93%) and forehead (2 of 10; 20%) were dysplastic. The number of dysplastic nevi from the neck (1 of 58; 1.72%) was not assessed as very different from the incidence found in other regions of the body, where 7 dysplastic nevi (7.36%) from a total of 95 nevi were found. Of the 13 dysplastic nevi from the scalp, 9 showed minimal atypia and 4 showed moderate atypia. No nevi with severe atypia were found. Many pigmented nevi from the scalp and forehead in children in this study were dysplastic. This finding points out the importance of examining the scalp of children for the presence of dysplastic nevi. The majority of nevi from the neck were common nevi.

Adolescent↗
PubMed1998

Reconstruction of scalp defects with free flaps in 30 cases.

29 consecutive patients treated for reconstruction of various scalp defects with 30 free flaps were reviewed. The scalp defects resulted from accidents (13), electric burns (4), tumour excision (8), chronic osteomyelitis (1), and osteoradionecrosis (1). Secondary reconstructions for cosmetic improvement were performed in 2 patients. The defects involved scalp with bone exposure in 21 patients, and both scalp and calvarium in 8 patients. The average extent of the defects was 130 cm2 (23-420 cm2). Free flaps employed for reconstruction included radial forearm flaps (15), latissimus dorsi muscle flaps (10), medial arm flaps (2), juri flap (1), rectus abdominis muscle flap (1), and scapular flap (1). In 6 cases bone grafts were used for skull reconstruction. Three patients required dura repair. There were two flap failures. Donor-site morbidity was negligible. No local recurrence occurred in 7 tumour cases who are still alive. Secondary procedures (tissue expansion, debulking) were performed in 6 patients. The authors recommend selection of reconstructive options for scalp defects according to their aetiology, localisation, and duration of treatment, whereas the size of the defect dose not seem to be the most important determinant. They conclude that a free flap procedure is appropriate for scalp reconstruction in trauma, osteomylitis, and osteoradionecrosis cases, and following radical resection of malignant tumours.

Accidents↗
PubMed1999

Microsurgical reconstruction of extensive scalp defects.

Large, full-thickness scalp defects represent a reconstructive challenge that has benefitted greatly from the introduction of microsurgical techniques. The authors review their experience with 16 patients with acquired defects of the scalp for which local or regional reconstructive options were unavailable. The mean age at the time of operation was 44.8 years. Nine patients underwent resection of malignant scalp lesions, followed immediately by free-flap coverage. Six patients required revision procedures for unstable scar as a result of prior trauma (2), old scalp avulsions (2), and multiple intracranial procedures (2). The remaining patient underwent replantation of an acutely avulsed scalp. The free-flap donor sites utilized included latissimus (6), scapular (3), radial forearm (2), rectus abdomnis (2), and omentum (2). Vein grafts were required in four cases. All flaps survived, although one required anastomotic revision and skin grafting for superficial loss. Additional complications were limited to seromas at two latissimus donor sites. Tumor control rates were poor, with all malignancy-associated defects having persistent disease or recurring soon after surgery. All patients eventually achieved full defect coverage. The authors conclude that microsurgical reconstruction is a reliable option for providing stable coverage of large, complex, scalp defects.

Adolescent↗
PubMed1995

Entire scalp replantation: case report and review of the literature.

A case of successful replantation of a totally avulsed scalp in a 40-year-old woman is presented. During a 19-hr surgical procedure, bilateral superficial temporal arteries and veins were anastomosed. The postoperative course was uneventful, except for partial necrosis of the distal end of the avulsed flap, i.e., the occipital region. Since the first successful scalp replantation using microsurgical technique was reported in 1976, the authors have found at least 32 subsequently reported cases. Of these, there were 22 cases of entire scalp avulsion (more than 80 percent of the scalp), including 15 females and seven males. A summary of these cases is included. From analysis of the reported cases of entire scalp avulsion, the keys to success in scalp replantation are considered to be the adequate selection of vessels for repair and the use of vein grafts, if necessary.

Adult↗
PubMed2002

Sensitivity of human scalp skin to pruritic stimuli investigated by intradermal microdialysis in vivo.

BACKGROUND: Although pruritus is common in scalp skin, the forearm has been the main site for investigation in previous experimental studies. OBJECTIVE: Our purpose was to compare the sensitivity to pruritic stimuli in human scalp and forearm skin. METHODS: Four microdialysis fibers were inserted intradermally into scalp (n = 10) or forearm skin (n = 10) of healthy male subjects and were perfused with histamine (0.01%) or compound 48/80 (C48/80; 0.05%) for 20 minutes. Total protein content in the dialysate was assessed at 10-minute intervals. Intensity of itching and pain sensation were measured psychophysically. RESULTS: Histamine- and C48/80-induced protein extravasation was significantly lower in scalp skin. Histamine and C48/80 invariably provoked an itching sensation in the forearm but only in 4 of 10 applications in the scalp. CONCLUSION: Despite the high prevalence of pruritus, scalp skin is less sensitive to histamine-induced experimental itching. A lower innervation density of pruritic nociceptors and/or different central processing of itching might account for this difference.

Adult↗
PubMed2004

High-resolution electroencephalogram (EEG) mapping: scalp charge layer.

The neural electrical signal related to the human brain function is one of the tracks to understanding ourselves. Various electroencephalogram imaging techniques have been developed to reveal spatial information on neural activities in the brain from scalp recordings, such as Laplacian, equivalent source layer and potential. Physically, these methods may be classified into two categories: scalp surface or cortical surface based techniques. In this work, the focus is on the scalp surface based equivalent charge layer (ECL), with a comparison to the scalp potential with different references and scalp Laplacian (SL). The contents include theoretical analysis and numeric evaluation of simulated data and real alpha (8-12 Hz) data. The results confirm the fact that SL and ECL are of higher spatial resolution than various scalp potential maps, and for SL and ECL, SL is of higher resolution but more sensitive to noise.

Brain↗
PubMed2005

Modelling of temperature and perfusion during scalp cooling.

Hair loss is a feared side effect of chemotherapy treatment. It may be prevented by cooling the scalp during administration of cytostatics. The supposed mechanism is that by cooling the scalp, both temperature and perfusion are diminished, affecting drug supply and drug uptake in the hair follicle. However, the effect of scalp cooling varies strongly. To gain more insight into the effect of cooling, a computer model has been developed that describes heat transfer in the human head during scalp cooling. Of main interest in this study are the mutual influences of scalp temperature and perfusion during cooling. Results of the standard head model show that the temperature of the scalp skin is reduced from 34.4 degrees C to 18.3 degrees C, reducing tissue blood flow to 25%. Based upon variations in both thermal properties and head anatomies found in the literature, a parameter study was performed. The results of this parameter study show that the most important parameters affecting both temperature and perfusion are the perfusion coefficient Q10 and the thermal resistances of both the fat and the hair layer. The variations in the parameter study led to skin temperature ranging from 10.1 degrees C to 21.8 degrees C, which in turn reduced relative perfusion to 13% and 33%, respectively.

Blood Flow Velocity↗
PubMed1998

The influence of scalp infiltration with bupivacaine on hemodynamics and postoperative pain in adult patients undergoing craniotomy.

UNLABELLED: After craniotomy, hypertension may contribute to intracerebral hemorrhage. We studied whether scalp infiltration with bupivacaine during craniotomy reduces postoperative pain and hypertension. In a double-blind fashion, 36 adult patients (ASA physical status II or III) undergoing elective craniotomy were randomly assigned to receive scalp infiltration with either bupivacaine (0.25%) and epinephrine (1:200,000) or saline/ epinephrine (1:200,000) for skeletal fixation, skin incision, and wound closure. Heart rate (HR) and mean arterial pressure (MAP) were measured after anesthesia induction, after skull-pin insertion, after scalp infiltration, during dural closure, during skin closure, on admission to postanesthesia care unit (PACU), and 1 h after admission. Visual analog pain scores were recorded in the PACU. MAP was significantly greater in the saline group at scalp infiltration. HR was significantly faster in the saline group at dural and skin closure. The bupivacaine group reported significantly less pain than the saline group at PACU admission and 1 h after admission. Pain scores did not correlate with hemodynamic measurements. We conclude that scalp infiltration with 0.25% bupivacaine with 1:200,000 epinephrine blunts certain intraoperative hemodynamic responses and reduces postoperative pain but has no effect on postoperative hemodynamics. IMPLICATIONS: We sought to evaluate whether scalp infiltration with bupivacaine and epinephrine at the beginning and end of craniotomy would afford more intra- and postoperative hemodynamic stability and influence immediate postoperative pain. We found that intraoperative hemodynamics were not influenced greatly; however, craniotomy patients do have significant postoperative pain, which does not seem to have an influence on hemodynamics in the postanesthesia care unit.

Adolescent↗
PubMed2001

Scalp nerve blocks decrease the severity of pain after craniotomy.

UNLABELLED: Up to 80% of patients report moderate to severe pain after craniotomy. In this study, we assessed the efficacy of scalp block for decreasing postoperative pain in brain surgery. Thirty patients scheduled for supratentorial craniotomy were enrolled. They were randomly divided into two groups: Ropivacaine (scalp block with 20 mL of ropivacaine 0.75%) and Saline (scalp block with 20 mL of saline 0.9%). Anesthesia was standardized. The scalp block was performed after skin closure and before awakening. Postoperative pain was assessed at 4, 8, 12, 16, 20, 24, and 48 h by using a 10-cm visual analog scale. Analgesia was provided with sub- cutaneous codeine as requested by the patient. Average visual analog scale scores were higher in the Saline group as compared with Ropivacaine (3.7 +/- 2.4 vs 2.0 +/- 1.6; P = 0.036). The total dose of codeine did not differ, nor did the duration of time before the first dose of codeine was required in the Ropivacaine (571 +/- 765 min) versus Saline (319 +/- 409 min; P = 0.17) group. In conclusion, we found that postoperative scalp block decreases the severity of pain after craniotomy and that this effect is long lasting, possibly through a preemptive mechanism. IMPLICATIONS: Up to 80% of patients report moderate to severe pain after craniotomy. This randomized double-blinded study demonstrated that ropivacaine scalp block decreases the severity of pain after supratentorial craniotomy.

Adolescent↗
PubMed1984

Skin expansion to eliminate large scalp defects.

In three children aged 3 to 8 years with large scalp defects temporary expanders of silicone elastomer were inserted under the scalp above the pericranium and under the galea through an incision at the junction of the defect and the normal scalp. Over the following six to eight weeks, the expanders were inflated weekly or semiweekly with injections of saline. During expansion, hair growth continued. When the scalp flap expansion was completed, the scalp margin was advanced. Two of the 3 patients required additional expansion, so a deflated expander was left under the scalp. The entire defect was covered in each case. This technique has wide application for a variety of reconstructive problems.

Child↗
PubMed1997

Tension and flap advancement in the human scalp.

The aim of the present study was to evaluate quantitatively the change in stiffness of scalp flaps determined by increased loads of tension. Data were collected by stepwise loading 20 scalp flaps, created by a reversed-Y incision down to and through the galea aponeurotica together with undermining. In the layer between the galea and the pericranium, to within 1 cm of the external auditory canal. The biomechanical properties of the tested scalp flaps were significantly influenced by increased extents of tension. The tissue's stress response to displacement was visualized as a three-phase characteristic. Initially linear (indicative load range, 0 to 500 g), the scalp's compliance gradually reduced (indicative load range, 500 to 1,500 g) and eventually demonstrated an exponential stress/strain characteristic of rapidly increasing stiffness (indicative load range, 1,500 to 5,000 g). The Young's modulus, E, of the stress/strain curve was found to be equal to 49.2 g per millimeter. The obtained data suggest that a reasonable approach should consist of closing a scalp defect within the tension range of 500 to 1,500 g. This will take full advantage of the plasticity of the scalp flap. The gain obtained with a closing tension above this range would be minimal, with a presumably increased complication rate.

Adult↗
PubMed1998

Effects of galeotomies on scalp flaps.

The aim of the present study was to evaluate how much a relaxing incision of the galea aponeurotica affects the biomechanical properties of a scalp flap to quantify the surgery-related advantages provided by this procedure. Twenty scalp flaps, created by a reverse-Y incision down to and through the galea aponeurotica together with undermining (in the layer between the galea and the pericranium) to within 1 cm of the external auditory canal were studied. Data were collected by stepwise loading the scalp flaps before and after performing three full-thickness galeotomies lengthwise and parallel to the sagittal scalp incision. The tension/ extension ratio characteristics were computed, and loading curves as well as mean stiffness values were measured. A statistically significant difference (-16.6 g per millimeter) was found between the slope (computed as Young's modulus) of the curves obtained before and after performing the galeotomies. This value corresponded to a mean 40% reduction of the closing tension attained with each galeotomy. In the closing-tension interval 500 g to 1,500 g, the mean gain of length of the flap per galeotomy was 1.67 mm. These data confirm the usefulness of galeotomies for lengthening the scalp flaps and for diminishing the tension on wound margins when closing scalp defects.

Adult↗
PubMed2000

Replantation of avulsed scalps and secondary aesthetic correction.

Five patients with avulsed scalps were treated with replantation between 1992 and 1998. All patients were women age 20 to 36 years. The percentage of the avulsed scalp ranged from 50% to 100% of the whole scalp. The vessels chosen for anastomosis were the superficial temporal artery, occipital artery, and superficial temporal vein. A vein graft harvested from the cephalic vein of the forearm was performed on the venous and arterial sides in 1 patient. Two patients experienced complete survival of the replanted scalp. Three patients showed 40%, 50%, and 80% survival areas, with the remaining defects resurfaced as split-thickness skin grafts. Six months later, the scar areas in the last 3 patients were reconstructed with an expansion of the normal or replanted scalp. The follow-up period ranged from 1 to 7 years. In 4 patients a partial return of sensation in the replanted scalp and motor function of the frontalis muscle were observed. All patients were satisfied with the aesthetic results of their surgery.

Adult↗
PubMed1990

The scalp as a donor site: revisited.

The scalp cannot be used as skin graft donor site with impunity. A review of 2,620 charts identified 194 pediatric patients whose scalps served as donor sites for split-thickness skin grafts for the treatment of acute burns. The overall incidence of alopecia was 32%. However, the incidence of alopecia in unburned scalps was 13%. The occurrence of alopecia in this group was associated with larger burn area requiring more frequent use of the scalp and shorter intervals between graft harvests (p less than 0.05). Among this group of patients (n = 15), nine had mild spotty alopecia, four had surgically correctable alopecia, and two had global patchy alopecia not amenable to surgical correction. In the patients with concomitant burns to their scalps, the incidence of alopecia was 61%. Whether the burn or the graft harvest caused alopecia could not be established. Meticulous donor site care is mandatory in this latter group when the scalp donor site is indicated.

Adolescent↗
PubMed1994

Elimination of fetal scalp blood sampling on a large clinical service.

OBJECTIVES: To describe the use of fetal scalp blood sampling on a large teaching service over 7 years and to assess any association between changes in use and the rates of cesarean delivery for fetal distress and of various indirect indicators of perinatal asphyxia in term infants. METHODS: We reviewed computerized and tabular data bases for fetal scalp blood sampling, cesarean delivery for fetal distress, Apgar score, and the clinical diagnoses of asphyxia and meconium aspiration syndrome for the years 1986-1992. RESULTS: Live births averaged 16,330 annually. The rate of fetal scalp blood sampling for the first 3 years of the study period was 1.76%, consistent with the rate of 1.5-2.0% noted for the preceding decade at our institution. An increase in sampling in 1987 was followed by a steady decline over the next 4 years, to a low of 0.03% in 1992. During the period of declining scalp pH usage, there was no increase in the cesarean rate for fetal distress, low Apgar score (less than 5 at 5 minutes) requiring neonatal intensive care unit admission, or the clinical diagnosis of perinatal asphyxia or meconium aspiration syndrome. CONCLUSIONS: Fetal scalp blood sampling has been virtually eliminated without an increase in the cesarean rate for fetal distress or an increase in indicators of perinatal asphyxia. The role of fetal scalp blood sampling in clinical practice is questioned.

Apgar Score↗
PubMed1992

Repair of scalp defects using a tissue expander and Marlex mesh.

A simple technique using Marlex mesh and a tissue expander to cover scalp defects is described and two patients are presented. This technique is suitable for medium-sized defects that cannot be closed primarily. Marlex mesh is sutured to the wound edges in lieu of a temporary skin graft and to prevent enlargement of the defect during tissue expansion. The tissue expander is placed under adjacent normal scalp in a subgaleal pocket developed through the scalp defect. The scalp defect is closed secondarily using the expanded scalp flap. This technique was performed in two patients with satisfactory results. Marlex mesh obviates the need for a temporary skin graft to cover the scalp defect.

Adult↗
PubMed1999

Prevention and treatment of wide scar and alopecia in the scalp: wedge excision and double relaxation suture.

The visible linear scar of the scalp is a cosmetically serious complication of a scalp incision in scalp surgery, forehead lift, and craniofacial surgery, especially on the temporal scalp. Its causes are cicatrical alopecia and scar widening. To solve this problem, we performed the wedge excision of the scalp and the double relaxation suture of the galea in 2 patients undergoing facial surgery through the coronal approach and in 15 patients with scalp alopecia ranging from 0.5 to 3.0 cm in width. The wedge excision using the beveling incision at an angle of 30 degrees to the hair follicles preserves the deep hair follicles of the flap margins and allows the hair to grow into the scar, eventually preventing cicatricial alopecia and camouflaging the linear scar. The double relaxation suture of the trimmed galea with nonabsorbable suture with or without the relaxation incision minimizes skin tension for a long time, eventually preventing scar widening. This procedure was followed by the superficial skin suture for maintaining the skin sutures for a long time and avoiding the injury of the superficial hair follicles. In all patients, we observed an excellent cosmetic result of unnoticed scar line without complications during the follow-up period of 10 weeks to 6 months.

Adolescent↗