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At least 1,081 records · Page 60Linked to original sources
PubMed1996

Scarpa's adipofascial flap for repair of wide scalp defects.

Scarpa's fascia is a prominent superficial fascial system of the body. It consists of a single membrane between the superficial fatty layer and deep fatty layer, and lies widely in the lower abdominal wall. We describe a case with a wide scalp defect resulting from a resection of a dermatofibrosarcoma, and reconstruction of the defect with Scarpa's adipofascial flap (i.e., a combined paraumbilical perforator-based adipofascial flap-groin adipofascial flap). The primary advantage of Scarpa's adipofascial flap for scalp defects is that (1) the donor site is most acceptable for a free flap with a minimal donor scar and minimal dysfunction; (2) even in cases in which large flaps are used, donor defects can be closed directly without skin grafting; (3) in the obese patient, this flap is preferable because of cosmetic improvement of the abdominal wall; (4) the donor area has so many perforators that an extended adipofascial flap can be obtained with a combination of these perforators; and (5) the flap may be nourished with one of several arteries, such as the superficial or deep inferior epigastric artery, or the superficial or deep circumflex iliac artery. The disadvantages of this flap are that the territory with a single artery may be smaller than a skin flap with the same artery and oversurfacing of the graft results in a poor cosmetic appearance. Scarpa's adipofascial flap is indicated when the defects are in an exposed area, especially in children, young patients, and females, and when this procedure is combined with a skin-expanding method in the secondary repair.

Adipose Tissue↗
PubMed1999

Prenatal pressure necrosis of the scalp.

A case of full-thickness pressure necrosis of the scalp in a newborn is reported. This is a rare injury, with only four similar prior reports found in the literature. The presumed mechanism of injury is pressure of the infant's head against the mother's bony pelvis. A spectrum of injury can be seen, from temporary alopecia to complete scalp necrosis. Risk factors include prolonged ruptured membranes and prolonged labor.

Child, Preschool↗
PubMed2002

Surgical treatment of aplasia cutis congenita of the scalp associated with bilateral coronal synostosis.

Aplasia cutis congenita is a rare condition characterized by the congenital absence of skin. The authors report a case of aplasia cutis congenita of the scalp associated with bilateral coronal synostosis. Simultaneous fronto-orbital advancement and skull reconstruction for large defect at the fontanelle were performed in the initial operation. A tissue expander made it possible to resect most of the hairless scar and totally cover the reconstructed defect and skull. During the second stage, the residual hairless scar was completely covered with hair-bearing scalp by tissue expansion and the residual skull defects were successfully reconstructed with split calvarial bone grafting.

Alopecia↗
PubMed2002

Scalp necrotizing fasciitis with osteomyelitis of the skull from Aspergillus.

Necrotizing fasciitis of the scalp is a life-threatening condition. When Aspergillus is the infectious organism, treatment of the wound and salvage of the patient become a formidable challenge. The authors present an extremely rare case of the successful treatment of scalp necrotizing fasciitis combined with osteomyelitis of the calvarium involving Aspergillus.

Aspergillosis↗
PubMed2006

Squamous cell carcinoma arising from an arteriovenous malformation of the scalp.

We present the case of a 70-year-old man with a congenital scalp lesion consistent with an arteriovenous malformation (AVM) which over the last 3 years had developed ulcerative changes and bleeding in the central aspect that was a biopsy proven squamous cell carcinoma (SCCA). To control hemorrhage during surgery, a radiologist performed selective embolization of major feeding arteries in the lesion three days before the surgery. After total resection of the lesion, a scalp reconstruction was performed by using a free latissimus muscle flap and skin graft. As a result, bleeding was well controlled, the AVM and SCCA were totally resected, and satisfactory aesthetic results were obtained. This appears to be the first description of a SCCA arising from a chronic AVM. This is suggestive of a possible Marjolin's ulcer from a chronic wound bed.

Aged↗
PubMed1994

Generator mechanism of pain-related evoked potentials following CO2 laser stimulation of the hand: scalp topography and effect of predictive warning signal.

In order to clarify the generator mechanism of pain-related evoked potentials (pain EPs), we studied the scalp topography of the pain EPs following CO2 laser stimulation of hand dorsum by using balanced sternovertebral electrodes as the noncephalic reference in 11 normal volunteers. We also examined the effects of predictive warning signal (light-emitting diode) on the pain EPs. In both the warned and unwarned conditions, all of the 22 hand stimulations showed a large negative component (N2) at the peak latency of about 213 ms followed by a large positive component (P2) at the peak latency of about 329 ms. A preceding small negative component (N1) at the peak latency of about 148 ms was detected in 12 of the 22 hand stimulations in the warned condition and in 13 of the 22 hand stimulations in the unwarned condition. P2 was significantly larger and occurred earlier in the warned condition than in the unwarned condition, whereas other components did not differ between the two conditions, suggesting that an increased attention of the subject to the stimulus influenced the generator mechanism of the P2 component. With regards to the scalp topography, N2 was maximal at Cz and widespread transversely to both sides, whereas P2 was maximal at Cz or Pz and spread more posteriorly than N2. These findings suggest that P2 is generated by a different mechanism from N2 and is most likely associated with pain-related cognitive function. N1 was localized to the contralateral central and midtemporal areas, confirming that the nociceptive inputs are perceived in the sensory cortex in humans. The question as to whether the N1 component is generated in the hand area of the primary somatosensory cortex or in the secondary somatosensory cortex, or in both areas, remains to be solved.

Adult↗
PubMed2001

Individually optimizing posterior tibial somatosensory evoked potential P37 scalp derivations for intraoperative monitoring.

This investigation sought the optimal (highest amplitude) derivation for monitoring the posterior tibial P37 for each side in each individual, and determined whether this may change intraoperatively. Fifty monitored patients were studied using a partial P37 map consisting of FPz, Fz, Cz, Cz', Pz, POz, C4', and C3' to a noncephalic reference. From this, the highest amplitude scalp derivation was determined for each side. Of 100 tibial nerves, the initial optimal input 1 was Cz' in 52%, Pz in 28%, and Cz or iC' in 10%, and optimal input 2 was cC' in 69% and FPz in 31%. The optimal derivation was the same for each side in 34% of patients and different in 66%. Of 31 patients with at least one subsequent trial later during surgery, P37 topography changed in 14 and affected optimal inputs in 12. This occurred regularly during sitting-position posterior fossa surgery because of intracranial air, but sometimes occurred during other surgeries as well. The most common change consisted of FPz replacing cC' as optimal input 2. Input 1 changes were predominantly in an anterior or posterior sagittal direction. The results demonstrate great inter- and intraindividual P37 variability, and document intraoperative topographic changes. Both phenomena can be addressed by a practical method to refine intraoperative monitoring by individually optimizing scalp derivations and identifying topographic P37 changes during surgery.

Evoked Potentials, Somatosensory↗
PubMedDate not supplied

Nearest neighbor phase synchronization as a measure to detect seizure activity from scalp EEG recordings.

The author presents results from the application of a particular measure for synchronization between brain areas (i.e., phase synchronization) in its behavior to detect epileptic seizure activity from scalp EEG recordings. The primary motivation for the current study was to contribute to the development of physiologic measures that both transform the EEG to a visual domain that allows a more intuitive interpretation of the interictal and ictal EEG and allows automated analysis, both relevant for real-time monitoring. EEGs from 16 patients experiencing temporal lobe and generalized seizures were analyzed. Nearest neighbor phase synchronization (NNPS) values for several frequency bands were determined. Additional analysis of the NNPS in the delta band, using different thresholds, allows construction of receiver operating characteristics (ROC) curves for each EEG analyzed. The common value for the sensitivity and the specificity, Q*, was used as a measure for the test accuracy, with values of Q* near 1.0, indicating ROC curves with sensitivity and specificity both approaching 1.0. It was found that Q* = 0.48 to 0.87, depending on the EEG analyzed, indicating that the proposed method allows seizure detection in a significant portion of the EEGs studied. Nearest neighbor phase synchronization was typically increased during seizure activity and seems to be a promising method to detect seizure activity from scalp EEG recordings. The proposed visualization allows an intuitive interpretation of the EEG and may assist in real-time monitoring.

Cortical Synchronization↗
PubMedDate not supplied

Clinical and imaging anatomy of the scalp.

The purpose of this paper is to illustrate the clinical and imaging anatomy of the scalp. The territories of the vessels, lymphatics, and nerves together with the epicranial muscles of the galea are illustrated. The traditional cross-sectional anatomic layers are described and their gross anatomic boundaries are given. They are regrouped into 3 coverings that can be distinguished on normal and pathologic magnetic resonance (MR) and computed tomography (CT) imaging. These are the epidermis/dermis, the subcutaneous layer, and the galea/subgalea/periosteum complex. This information will provide a handy reference to help describe scalp lesions.

Humans↗
PubMed1985

Microsurgical replantation of the scalp.

Our 7-year experience with seven patients who had suffered avulsion of 30% or more of the scalp is reviewed. Six of the seven, who were candidates for microsurgical replantation, underwent successful replantation with 100% survival in five, and 50% survival in one. All had luxuriant regrowth of hair. The mechanisms of injury, emergency management, indications, and operative techniques are discussed. The role of interpositional vein grafts, and choice of vessels in contributing to this success is emphasized. The superiority of replantation over other methods of reconstruction of major scalp defects is demonstrated.

Accidents, Occupational↗
PubMed1998

Combining free flap reconstruction and craniofacial prosthetic technique for orbit, scalp, and temporal defects.

OBJECTIVES: To identify factors leading to successful application of prosthetic techniques following free flap reconstruction of the orbit, scalp, and temporal region. STUDY DESIGN: Retrospective review. METHODS: Twenty-eight patients who underwent free flap reconstruction for defects of these regions between 1989 and 1996 were reviewed for clinical parameters, flap loss, patient survival, and implant loss rate. Prosthetic usage rates were compared before and after introduction of a site-specific reconstructive algorithm. RESULTS: Free flap success rate was 93%, whereas osseointegrated implant loss rate was 11%. In addition to implants, a reconstructive strategy that provided thin, vascular tissue between bone and skin, a flat platform in the temporal region, and preservation of orbital cavity depth led to increased prosthetic usage. CONCLUSIONS: Craniofacial prosthetic techniques can significantly augment the results of free flap surgery for the orbit, scalp, and temporal region. Successful combination of these techniques requires a site-specific surgical approach.

Adolescent↗
PubMed1982

Role of scalp reduction in the treatment of male pattern baldness.

Scalp reduction applies the principle of staged excision to the alopecic area in male pattern baldness. Two to rarely five excisions are performed as outpatient office procedures under local anesthesia. The reduction greatly enhances the results obtainable by supplementary hair transplantation and may reduce or eliminate the need for it. A personal series of 30 patients is presented. Technique and expected results are illustrated. Complications and limitations of the method are discussed. Wider consideration of scalp reduction in the treatment of patients seeking hair restoration is encouraged.

Adult↗
PubMed1983

Congenital scalp defect with distal limb anomalies: brachydactyly and hypoplastic toes.

A case report of a congenital scalp defect with distal limb anomalies is presented. Etiology, associated anomalies, treatment, complications, and mortality are reviewed. The presence of prominent scalp veins may be an indication to defer rotation flaps and to obtain immediate coverage with a split-thickness skin graft after excision of the eschar.

Abnormalities, Multiple↗
PubMed1985

Aplasia cutis congenita of the scalp: delayed closure complicated by massive hemorrhage.

A case of aplasia cutis congenita involving the scalp, cranium, and dura is presented to illustrate the complication of major hemorrhage from the sagittal sinus that may occur if closure is delayed. Subsequent problems with scalp-flap cover eventually required split-skin grafting of the defect. The case for surgery as soon after birth as possible is reinforced.

Adolescent↗
PubMed1985

Injuries causing major loss of scalp.

Long hair worn by both sexes in a majority of the rural population of Punjab (India) increases the hazard of descalping injuries. Forty-six cases seen over a period of 10 years are reported. Agricultural machinery accounted for 83 percent of these injuries. Males were most commonly involved (63 percent), and 48 percent of the patients were minors. Nearly all cases reported had at least half the scalp avulsed, 56.5 percent being total scalp avulsions, with bare bone exposed in 48 percent of the total. The method of chiseling the outer portion of the exposed bone down to bleeding points and immediately applying a split-thickness skin graft is presented as the procedure of choice for wound closure. This reduced the average hospitalization period by 49 percent as compared with older methods. Follow-up of 67 percent of patients has revealed a surprising instability of the grafted skin, with an ultimate danger of malignant degeneration.

Adolescent↗
PubMed1986

Total reconstruction of aplasia cutis congenita involving scalp, skull, and dura.

A case of total reconstruction of skull and scalp in a patient with a large defect from aplasia cutis congenita is reported. Tissue expansion was successfully employed on two occasions: first to construct a well-vascularized space to sustain multiple rib grafts for cranial reconstruction and then to develop adequate quantities of scalp and forehead for total coverage.

Child↗
PubMed1987

Skin graft from a scalp flap.

We present a case of scalp avulsion treated with a transposition scalp flap utilizing a split-thickness skin graft from the flap. Using the flap as a donor site confined the operation to a single anatomic region and saved the patient an additional donor-site scar. The flap healed uneventfully with normal regrowth of hair, the donor site was well concealed, and there was complete take of the split-thickness skin graft.

Child, Preschool↗