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At least 307 records · Page 17Linked to original sources
PubMed2001

Replantation and triple expansion of a three-piece total scalp avulsion: six-year follow-up.

Total scalp avulsion in three scalp segments is an unusual injury. The authors describe the replantation of three scalp segments in a 15-year-old girl. Replantation of the middle scalp piece was unsuccessful, but a satisfactory aesthetic and functional result was obtained by expanding the same replanted tissue three times. Every effort should be undertaken to save the avulsed scalp, even in a severely damaged situation.

Adolescent↗
PubMed1993

Management of large scalp defects with local pedicle flaps.

Recent reports have emphasized free-flap reconstruction for large defects of the scalp and calvarium following resection of tumors, infection, or trauma. In most cases, however, a carefully planned local transposition or rotation flap may be equally effective, and the technical difficulties and donor-site problems associated with microsurgical tissue transfer are then avoided. We present 10 patients whose full-thickness scalp defects covered an average area of 241 cm2, or 27 percent, of the skull surface. Although this series included defects as large as 450 cm2, or 50 percent, of the skull surface area, each was easily managed with a local pedicle flap transfer. Four patients were reconstructed with parietal scalp transfer, four with an occipital scalp flap, and two with temporal scalp transfer. The technique and results are discussed.

Adolescent↗
PubMed2001

Bipedicled fronto-occipital flap for reconstruction of postoncologic defects of the lateral scalp.

Presented here are two clinical cases of extensive defects of the scalp secondary to surgical resection of invasive basal cell carcinoma on the parietal region, successfully treated by means of very large, bipedicled fronto-occipital flaps, based anteriorly on the supratrochlear-supraorbital vessels and posteriorly on the occipital and posterior auricular vessels. Considering both the location and the large size of the scalp defects, different surgical techniques are discussed and the potential use of bipedicled scalp flaps is considered, designed either sagittally or coronally as fronto-occipital or temporo-temporal flaps. The bipedicled fronto-occipital scalp flap is believed to represent a simple, secure, and useful reconstructive procedure for cutaneous coverage of extensive defects located on the lateral scalp.

Aged↗
PubMed1998

Transplantation of vascularized allogeneic skeletal muscle for scalp reconstruction in a renal transplant patient.

BACKGROUND: We report the case of a vascularized allogeneic skeletal muscle transplant (VASM) and autologous skin grafting as rescue therapy for refractory squamous cell carcinoma of the scalp. METHODS: A renal transplant recipient with recurrent squamous carcinoma of the scalp underwent an excision that resulted in a 11 x 14 cm2 scalp defect with exposed cranium. At the time of multiorgan procurement, a section of rectus abdominis and external oblique muscle and fascia with its independent vascular bundle was isolated and stored in cold University of Wisconsin solution. The patient received methylprednisolone and rabbit antithymocyte globulin intravenously during scalp preparation, before single-vessel anastomosis of the deep inferior epigastric vascular bundle from the donor muscle to the recipient neck vessels. An autologous split-thickness skin graft was secured to the surface of the allogeneic muscle. RESULTS: Immunosuppression was maintained with prednisone and cyclosporine. Serial VASM biopsies were used to evaluate acute rejection. Perivascular lymphocytic infiltrates and rare focal myonecrosis were evident on biopsy at 2 weeks postoperatively, and mycophenolate mofetil was added. Subsequent VASM biopsies showed predominately interstitial and perivascular T-cell lymphocytic infiltrates interpreted as consistent with mild rejection, but the allograft appeared intact without clinical evidence of rejection. On postoperative week 18, the mycophenolate mofetil was discontinued. There has been no evidence of recurrence or metastasis. The patient remains ambulatory with a healed scalp 12 months after the VASM. CONCLUSION: The success of this first allogeneic skeletal muscle transplant is encouraging and provides another reconstruction option for wounds in transplant patients on chronic immunosuppression.

Animals↗
PubMed2006

Advances in scalp reconstruction.

PURPOSE OF REVIEW: The present review summarizes traditional and advanced techniques used to reconstruct defects of the scalp. These deformities range from small defects that can be closed primarily to significant defects, which require free tissue transfer. RECENT FINDINGS: Increased use of tissue expanders, advancement rotational flaps, and hair transplantation has resulted in improved cosmetic outcomes for larger defects of the scalp. Free tissue transfer has provided a revolutionary method of reconstructing subtotal and total defects of the scalp, in particular those associated with neoplasms. SUMMARY: New advances in techniques of scalp reconstruction have provided improved outcomes in terms of cosmetic appearance and decreased morbidity for scalp reconstruction.

Hair↗
PubMed2006

The scalp is an advantageous donor site for thin-skin grafts: a report on 945 harvested samples.

BACKGROUND: Thin-skin grafts taken from the thigh or buttock take a long time to heal and leave permanent scars. METHODS: The authors conducted a retrospective study based on their experience with 945 thin-skin grafts (0.2 mm) taken from the scalps of 757 adult patients between January of 1999 and December of 2003. RESULTS: Of the 757 patients, 89 had grafts taken repeatedly from the scalp. The mean healing time was 6.2 days for a single harvest and 10.2 days for repeated (same hospitalization) harvests. During follow-up, eight patients had microalopecia and three developed "concrete scalp deformity." Of these 11 patients, eight had undergone repeated harvests. None of the other patients had any scarring; they were completely healed by day 15. CONCLUSIONS: The results of this study confirm the rapidity of scalp healing compared with other donor sites. Providing patients with clear, detailed explanations helps minimize the psychological impact of having their heads shaved, and a rigorous technique can contain the two major potential risks: hemorrhage and alopecia. The adult scalp seems to be a donor site to be exploited whenever possible.

Cicatrix↗
PubMed1988

delta 5-3 beta-hydroxysteroid dehydrogenase activity in sebaceous glands of scalp in male-pattern baldness.

Sebaceous glands were isolated by manual dissection using a stereomicroscope from skin specimens of bald scalp of men with male-pattern baldness undergoing hair transplant or scalp reduction surgery and also from specimens taken from hairy and bald areas of scalp at autopsy of adult male victims of accidental death within 3 h post mortem. Homogenates of the isolated glands exhibited activities of delta 5-3 beta-hydroxysteroid dehydrogenase (3 beta HSD), 17 beta-hydroxysteroid dehydrogenase, and testosterone 5 alpha-reductase by the conversion of [3H]dehydroepiandrosterone (DHA) to 3H-delta 4-androstenedione (AD), [3H]testosterone, and [3H]dihydrotestosterone. Homogenates of glands from bald (B) scalp had greater 3 beta HSD activity than homogenates of glands from hairy (H) scalp. After differential centrifugation, 3 beta HSD activity was found mainly in the microsomal and 105,000 X g supernatant fractions. Specific activity of the enzyme based on protein mass was highest in the microsomal fraction; however, the total 3 beta HSD activity in the 105,000 X g supernatent of B glands was significantly (p less than .01) greater than that of H glands. 3 beta HSD activity in sebaceous glands isolated from autopsy specimens did not differ from that of glands isolated from surgical specimens in apparent Km (0.13-0.14 microM), pH optima (8.0), or coenzyme requirement for NAD. Since substantial 3 beta HSD activity was present in the cytosol, and cytosol of B glands showed increased 3 beta HSD activity, the increased conversion of DHA to AD may be a critical step for androgenic action and may be responsible for excessive androgenicity in male-pattern baldness.

3-Hydroxysteroid Dehydrogenases↗
PubMed1991

Characterization of 5 alpha-reductase in cultured human dermal papilla cells from beard and occipital scalp hair.

In order to gain a deeper insight into the role of 5 alpha-reductase in the growth of beards in men, we studied some kinetic properties of the enzyme in cell homogenates of cultured human dermal papilla cells from beard and occipital scalp hair. When cell homogenates were incubated with [3H]-testosterone, the 5 alpha-reductase of beard dermal papilla cells exhibited an optimum activity at pH 5.5, whereas the enzyme of dermal papilla cells from occipital scalp hair showed a broad and low plateau between pH 6.0 and 9.0, without a sharp peak. The apparent Michaelis constant of 5 alpha-reductase was 3.3 x 10(-7) M in dermal papilla cells from beard and 2.4 x 10(-5) M in those cells from occipital scalp hair. The apparent Km of 5 alpha-reductase for NADPH was 2.8 x 10(-5) M and 7.6 x 10(-4) M in beard and occipital scalp hair dermal papilla cells, respectively. There were no significant differences in the substrate specificity between these two types of cells. The 5 alpha-reductase activity was recovered mainly in the nuclear fraction of beard dermal papilla cells. By contrast, it was widely distributed among the individual subcellular fractions of dermal papilla cells from occipital scalp hair. These results strongly suggest that these two kinds of dermal papilla cells have different types of 5 alpha-reductase, and that the enzyme in beard dermal papilla cells is similar in characteristics to that in the androgen target organs such as prostate.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed2005

Substantial sex-dependent differences in the response of human scalp hair follicles to estrogen stimulation in vitro advocate gender-tailored management of female versus male pattern balding.

In this study, it was investigated how estrogens (17-beta-estradiol, E2) affect the estrogen receptor (ER) expression and gene regulation of male versus female human scalp hair follicles in vitro. Anagen VI follicles from frontotemporal scalp skin were microdissected and organ-cultured for up to 9 d in the presence of E2 (1-100 nm). Immunohistochemistry was performed for ERbeta-expression, known to be predominant in human scalp hair follicles, and for TGF-beta2-expression (as negative key hair growth modulator), and E2-responsive genes in organ-cultured human scalp hair follicles (48 h, 10 nM) were explored by cDNA microarray, using a commercial skin focus chip (Memorec, Cologne, Germany). The distribution pattern of ERbeta and TGF-beta2-immunoreactivity differed between male and female hair follicles after 48 h culture. Of 1300 genes tested, several genes were regulated sex-dependent differently. The study reveals substantial sex-dependent differences in the response of frontotemporal human scalp hair follicles to E2. Recognition and systematic dissection of the E2-dependent gene regulation will be crucial for the development of more effective, gender-tailored management strategies for female versus male pattern balding.

Alopecia↗
PubMed2005

Modern external beam radiation therapy for refractory dissecting cellulitis of the scalp.

BACKGROUND: Dissecting cellulitis of the scalp can be an extremely painful and disfiguring dermatological condition. The associated pain can be severe enough in some cases to require opioid analgesics, and this pain in conjunction with the disfigurement can induce significant emotional distress. Conservative treatments often fail to provide relief. Radiation therapy has been successfully used in the past but with outdated equipment and techniques. OBJECTIVES: To evaluate the efficacy and toxicity of modern external beam radiation therapy techniques for the treatment of dissecting cellulitis of the scalp. METHODS: Four patients with intractable dissecting cellulitis of the scalp were treated with electrons or a combination of electrons and photons to the entire scalp. Daily fraction sizes were 2.5 or 3 Gy and initially prescribed to 15-21 Gy. Patients were re-evaluated 3-4 weeks after completion of therapy. Any residual hair growth was treated with additional radiation treatments to ensure full epilation, up to a maximum dose of 35 Gy. RESULTS: Rapid resolution of pain was seen in all patients with pain. Regression of nodules and decreased discharge was seen in all patients following treatment and cosmesis was subjectively improved. No long-term toxicity has been observed. CONCLUSIONS: Using modern techniques and equipment, radiation therapy appears to be a reasonable option for patients with severe/refractory dissecting cellulitis of the scalp. Acute effects are mild and well tolerated. Aside from alopecia, which was present to some extent in all patients before treatment, no long-term complications have been observed.

Adult↗
PubMed2006

Randomized, double-blind, placebo-controlled prospective study of the efficacy of topical anaesthesia with a eutetic mixture of lignocaine 2.5% and prilocaine 2.5% for topical 5-aminolaevulinic acid-photodynamic therapy for extensive scalp actinic keratoses.

BACKGROUND: Photodynamic therapy (PDT) is an effective treatment modality for the treatment of extensive scalp actinic keratoses (AKs), but pain is a significant drawback when treating large areas with topical PDT using 5-aminolaevulinic acid (ALA) as sensitizer. A recent study has shown that use of tetracaine gel (Ametop) did not significantly reduce pain associated with PDT. OBJECTIVES: To assess the benefit of a eutetic mixture of lignocaine 2.5% and prilocaine 2.5% (Emla) on pain during topical ALA-PDT treatment of scalp AKs. METHODS: Fourteen men aged 59-83 years with extensive scalp AKs were recruited into a double-blind placebo-controlled study. Two treatment fields were defined (right and left frontal scalp) and were treated 2 weeks apart. These fields were randomized to receive either Emla or Aqueous cream as first or second treatment. ALA 20% cream was applied for 4 h. Topical anaesthesia or Aqueous cream was applied for 2 h. Pain was assessed using a visual analogue scale (0-100 mm) at 3, 6, 12 and 16 min. The instrument used for this was a blinded counter with one side reading 'no pain' to 'worst pain ever' with a numerical scale (0-100) on the reverse side. Pain scores were assessed looking at median and interquartile range and confidence intervals and calculating differences between treatment groups and analysing them using a paired t-test. RESULTS: Thirteen patients received treatment to both fields. No significant difference in mean pain scores was seen with the use of Emla cream compared with placebo during treatment of scalp AKs (P = 0.328). There was no significant difference in requirement for oral analgesia following PDT between the two groups (P = 0.06). CONCLUSIONS: Our data do not support the routine use of topical anaesthesia with Emla for topical PDT.

Aged↗
PubMed1993

Continuous intrapartum fetal monitoring: a prospective randomized comparison of 2 types of fetal scalp electrode.

This trial was conducted to compare 2 commonly used fetal scalp electrodes with regard to ease of use, frequency and extent of neonatal injury and quality of cardiotocographic record. A randomized design was employed to study a group of 106 patients divided between a Surgicraft Copeland clip fetal scalp electrode (52 patients) and a Meditrace spiral single helix scalp electrode (54 patients). Patients were eligible for trial entry if they required an intrapartum fetal scalp electrode, at term with a singleton cephalic pregnancy. Ease of application was rated by the operator using a linear analogue score. Unidentified traces were reviewed independently for quality by 2 obstetricians and neonates were examined on day-2 postpartum for injury. The Meditrace spiral fetal scalp electrode was significantly easier to apply (unpaired t-test p < 0.02). It also obtained higher ratings for trace quality (unpaired t-test p < 0.02). There were no serious neonatal injuries and no difference was found between the 2 electrodes in this regard.

Adult↗
PubMed2006

Scalp tumors treated with Mohs micrographic surgery: clinical features and surgical outcome.

BACKGROUND: There are only a small number of reports on the outcome of scalp tumors treated with Mohs micrographic surgery (MMS). OBJECTIVE: The objective was to present a large series of patients with scalp tumors treated with MMS in Australia between 1993 and 2002. METHODS: This prospective, multicenter study included all patients with scalp tumors who were monitored by the Skin and Cancer Foundation Australia. The variables analyzed were patient demographics, reason for referral, preoperative tumor size and postoperative defect size, recurrences before MMS, histologic subtypes, perineural invasion, and 5-year recurrence. RESULTS: The study included 316 patients (68% men) with a mean age of 65+/-15 years. The most common tumors were basal cell carcinoma (BCC), 57.9%; squamous cell carcinoma (SCC), 35.8%; Bowen's disease (BD), 4.1%; and atypical fibroxanthoma (AFX), 1.6%. Recurrent tumors comprised 37% of cases. The recurrence rate for 70 BCC patients who completed the 5-year follow-up was 5.7%, and for 31 SCC cases it was 3.2%. No cases of recurrence were noted in the patients with BD and AFX. CONCLUSION: BCC was the most common scalp tumor managed by MMS. The low 5-year recurrence rate emphasizes the importance of margin controlled excision of scalp tumors.

Adult↗
PubMed2007

Artificial hair fiber restoration in the treatment of scalp scars.

BACKGROUND: There is presently no treatment for scalp scars that is fully satisfactory. The modalities of treatment currently in use are surgery, hair transplantation, and micropigmentation. Scalp implantation with artificial hair fibers is used by some physicians as an adjunctive treatment. OBJECTIVE: The objective was to assess the utility of artificial hair fibers to treat scalp scars. METHODS: Data were collected by the principal author from 10 hair restoration practitioners who tested polyamide hair fiber (Biofibre CE 0373/TGA by Medicap Ltd., Carpi (MO), Italy) implantation for scalp scars. RESULTS: Artificial hair fiber implantation occurred between June 1996 and December 2000, and observations continued until December 2004. Data from 54 scars from 44 patients treated showed: (1) no complications in 49 scars (90.7%); (2) mild adverse outcomes in 4 scars (7.4%)-temporary superficial inflammation-infection that subsided following topical cortisone and local/systemic antibiotic treatment; and (3) moderately adverse outcomes in 1 scar (1.9%)-significant inflammation and generalized infection requiring removal of artificial implant to alleviate. Occasional minor skin reactions, sebum plugs, and hyperseborrhea were successfully controlled and well accepted by patients. Fiber fall rate was 20% on average per annum. CONCLUSION: Data show that polyamide hair fiber restoration can be considered an adjunctive treatment for scalp scars in selected cases.

Adolescent↗
PubMed1990

Studies on the yeast flora in patients suffering from psoriasis capillitii or seborrhoic dermatitis of the scalp.

In 65 patients with scalp psoriasis or seborrhoic dermatitis of the scalp, stool specimens, tongue swabs and scalp scales were examined for yeasts. The stool specimens showed in 70.8% of the patient group massive and in 7.7% moderate yeast colonization. Yeasts were found in 47.7% of the tongue cultures and in 12.5% of the scalp scales. Candida albicans was the predominant pathogen in the faeces and on the tongue. In comparison with a control group, frequency of yeasts in faeces and on the tongue in patients with psoriasis capillitii and seborrhoic dermatitis of the scalp could be shown to be significantly higher.

Adult↗
PubMed1990

Excitation of the corticospinal tract by electromagnetic and electrical stimulation of the scalp in the macaque monkey.

1. The responses evoked by non-invasive electromagnetic and surface anodal electrical stimulation of the scalp (scalp stimulation) have been studied in the monkey. Conventional recording and stimulating electrodes, placed in the corticospinal pathway in the hand area of the left motor cortex, left medullary pyramid and the right spinal dorsolateral funiculus (DLF), allowed comparison of the actions of non-invasive stimuli and conventional electrical stimulation. 2. Responses to electromagnetic stimulation (with the coil tangential to the skull) were studied in four anaesthetized monkeys. In each case short-latency descending volleys were recorded in the contralateral DLF at threshold. In two animals later responses were also seen at higher stimulus intensities. Both early and late responses were of corticospinal origin since they could be completely collided by appropriately timed stimulation of the pyramidal tract. The latency of the early response in the DLF indicated that it resulted from direct activation of corticospinal neurones: its latency was the same as the latency of the antidromic action potentials evoked in the motor cortex from the recording site in the DLF. 3. Scalp stimulation, which was also investigated in three of the monkeys, evoked short-latency volleys at threshold and at higher stimulus intensities these were followed by later waves. The short-latency volleys could be collided from the pyramid and, at threshold, had latencies compatible with direct activation of corticospinal neurones. The longer latency volleys were also identified as corticospinal in origin. 4. The latency of the early volley evoked by electromagnetic stimulation remained constant with increasing stimulus intensities. In contrast, with scalp stimulation above threshold the latency of the early volleys decreased considerably, indicating remote activation of the corticospinal pathway below the level of the motor cortex. In two monkeys both collision and latency data suggest activation of the corticospinal pathway as far caudal as the medulla. 5. The majority of fast corticospinal fibres could be excited by scalp stimulation with intensities of 20% of maximum stimulator output. Electromagnetic stimulation at maximum stimulator output elicited a volley of between 70 and 90% of the size of the maximal volley evoked from the pyramidal electrodes. 6. Electromagnetic stimulation was also investigated in one awake monkey during the performance of a precision grip task. Short-latency EMG responses were evoked in hand and forearm muscles. The onsets of these responses were approximately 0.8 ms longer than the responses evoked by electrical stimulation of the pyramid.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗
PubMedDate not supplied

Fine needle aspiration cytology of metastatic scalp nodules.

OBJECTIVE: To analyze cases of palpable cutaneous/ subcutaneous scalp nodules and evaluate the clinical features and role of fine needle aspiration cytology (FNAC) in their diagnosis. STUDY DESIGN: A total of 1,022 cases of metastatic malignancies at various sites were analyzed over a period of two years. FNAC was performed as a routine outpatient procedure for palpable lesions and under ultrasound or computed tomographic guidance for nonpalpable, internal sites. Histologic correlation was done when possible. RESULTS: Eighteen cases were found to be metastatic scalp nodules. The scalp as a metastatic site constituted 1.76% of all metastatic sites, 7.72% of extranodal sites, and 15.3% of extranodal and extrahepatic sites. Of the 18 cases, 7 (38.9%) had primaries in the head and neck region (thyroid, 3; orbit, 1; tonsil, 1; tongue, 1; and parathyroid, 1). Cutaneous/subcutaneous metastasis was encountered in 58 patients, and the 18 cases of scalp metastasis constituted 31.03% of all cutaneous sites. CONCLUSION: Careful examination of the skin on the entire body, with particular attention to the scalp, should be done when a primary internal malignancy or recurrence is suspected. FNAC is a very helpful and cost-effective modality in determining the nature of such lesions.

Adolescent↗
PubMed2003

Efficacy of betamethasone valerate 0.1% thermophobic foam in seborrhoeic dermatitis of the scalp: an open-label, multicentre, prospective trial on 180 patients.

BACKGROUND: Seborrhoeic dermatitis (SD) is a common chronic inflammatory disease of the skin. Topical steroid creams and/or antifungal agents are commonly used in SD, but no resolutive therapies have been available up to now. Furthermore, little data have been available regarding clinical outcomes after cessation of topical treatments. A new formulation of betamethasone valerate 0.1% in a thermophobic, low-residue, foam vehicle (Bettamousse) (BVM) has become available for the topical treatment of scalp dermatoses. No data have been published hitherto regarding efficacy, safety and patient acceptability of this new formulation for the treatment of SD of the scalp. STUDY AIM: To assess in an open-label, prospective, multicentre trial, the efficacy, safety and patient acceptability of BVM, as compared to baseline, in SD subjects with scalp involvement. PATIENTS AND METHODS: A total of 180 patients with moderate-to-severe SD of the scalp were enrolled in the trial. Efficacy was evaluated by analysing SD lesions for erythema, scaling and itching using a five-point grading score (0 = lesion completely cured; 1 = mild; 2 = moderate; 3 = severe and 4 = very severe lesion). The clinical global (sum) score was obtained adding the score of each item. Efficacy and safety were assessed at baseline, after 4 weeks of active treatment, followed by an 8-week follow-up period with no treatment. RESULTS: In comparison with baseline, BVM significantly improved SD lesions. The sum score was reduced from 6.3 +/- 1.8 to 1.4 +/- 1.4 at the end of the active treatment period, (p < 0.0001) and to 1.7 +/- 1.8 at the end of the 8-week follow-up period (p < 0.0001). After active treatment, 93% of the patients had a sum score of </=3). At the end of 8-week of follow-up, 88% of patients maintained a sum score </=3. In addition, 85% of patients considered BVM foam to be a better topical formulation both in terms of efficacy and acceptability compared with previous treatments used. CONCLUSION: BVM is an effective and well-tolerated topical treatment of scalp SD. Its clinical effect is also maintained after a 2-month wash-out period.

Anti-Inflammatory Agents↗