Jeong Seong-Ho, Koo Sang-Hwan, Han Seung-Kyu, Kim Woo-Kyung
Department of Plastic Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.
Ann Plast Surg. 2010 Sep;65(3):330-7. doi: 10.1097/SAP.0b013e3181d2487a.
Although various methods for reconstruction of burn alopecia have been described in case reports and small case series, a comprehensive comparison of these methods has not been performed. The purpose of this study was to assess the appropriateness of the clinical indications for the various reconstructive methods for burn alopecia and suggest an algorithm for individualized reconstruction. A review of 83 patients who underwent reconstruction for burn alopecia between 1995 and 2007 was conducted. Demographics, associated injuries, preoperative findings, surgical techniques, and postoperative complications were collected. From these data, we classified reconstructive methods based on the area, the scar quality, and the location of the burn alopecia, and investigated the clinical outcomes. Reconstructive methods included hair grafting (n = 13), scalp reduction (n = 21), scalp extension (n = 14), and scalp expansion (n = 37). Hair grafting was mainly performed for reconstruction of small, good-quality burn alopecia located in the frontal or parietal area. Scalp reduction was primarily used in small or medium burn alopecia in which scar quality was good or moderate. Scalp extension was mainly performed for reconstruction of medium- and moderate-quality burn alopecia; scalp extension was particularly successful in the vertex region. Scalp expansion was the reconstructive procedure of choice for large, poor-quality burn alopecia. Twenty-eight (33.7%) patients experienced surgical complications and most of the complications were related to alloplastic implants used in scalp extension and expansion. The reconstructive method should be tailored to the conditions of the burn alopecia. Because scalp extension and expansion are associated with a high rate of complications, the authors recommend the use of these methods for large, poor-quality burn alopecia. On the other hand, hair grafting and scalp reduction are more appropriate treatment options for relatively small, good-quality burn alopecia.
尽管在病例报告和小样本病例系列中已描述了多种烧伤性秃发的重建方法，但尚未对这些方法进行全面比较。本研究的目的是评估各种烧伤性秃发重建方法临床适应症的适宜性，并提出个体化重建的算法。对1995年至2007年间接受烧伤性秃发重建的83例患者进行了回顾性研究。收集了人口统计学资料、相关损伤、术前检查结果、手术技术和术后并发症。根据这些数据，我们基于烧伤性秃发的面积、瘢痕质量和部位对重建方法进行了分类，并研究了临床结果。重建方法包括毛发移植（n = 13）、头皮缩减术（n = 21）、头皮延长术（n = 14）和头皮扩张术（n = 37）。毛发移植主要用于重建位于额部或顶叶区域的小面积、质量较好的烧伤性秃发。头皮缩减术主要用于瘢痕质量良好或中等的小面积或中等面积烧伤性秃发。头皮延长术主要用于重建中等面积和中等质量的烧伤性秃发；头皮延长术在头顶区域特别成功。头皮扩张术是大面积、质量较差的烧伤性秃发的首选重建方法。28例（33.7%）患者出现手术并发症，大多数并发症与头皮延长术和扩张术中使用的异体植入物有关。重建方法应根据烧伤性秃发的情况进行调整。由于头皮延长术和扩张术的并发症发生率较高，作者建议将这些方法用于大面积、质量较差的烧伤性秃发。另一方面，毛发移植和头皮缩减术是相对小面积、质量较好的烧伤性秃发更合适的治疗选择。
