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The Treatment of Linear and Narrow Scar after Craniotomy Using the Follicular Unit Excision

  • Hiromi Okochi (Department of Plastic and Reconstructive Surgery, Yamanashi University) ;
  • Masamitsu Onda (Shinwa Clinic) ;
  • Akira Momosawa (Department of Plastic and Reconstructive Surgery, Yamanashi University) ;
  • Masayuki Okochi (Department of Plastic and Reconstructive Surgery, Yamanashi University)
  • Received : 2021.12.07
  • Accepted : 2022.06.09
  • Published : 2022.11.15

Abstract

Background The scar alopecia after cranioplasty (SAC) may decrease the patient's quality of life. We have treated SAC using follicular unit extraction (FUE). The aim of this study was to discuss that efficacy of FUE and how much hair follicular unit (FU) should be transplanted intraoperatively for the treatment of SAC. Methods We treated 10 patients (4 men and 6 women) who had SAC using FUE. Results The average age, alopecia size, and intraoperative hair density on the graft area were 29.8 ± 12.1 years, 29.8 ± 44.5 cm2, and 34.6 ± 11.8 FU/cm2, respectively. One year postoperatively, the average hair survival rate on the graft area was 66.3 ± 6.1%. Hair appearance was rated as good in six, fair in three, and poor in one. Among patients whose 1-year postoperative hair density was ≥ 20 FU/cm2, five of six patients achieved good results. However, among patients whose 1-year postoperative hair density was < 20 FU/cm2, all four patients achieved fair or poor results. The postoperative hair density was significantly higher in patients whose 1-year postoperative hair density was ≥ 20 FU/cm2 than in patients whose 1-year postoperative hair density was< 20 FU/cm2. The rate of achieving fair or poor results was significantly higher if the postoperative hair density was < 20 FU/cm2 than if it was ≥ 20 FU/cm2 (p = 0.047). Conclusions FU excision is useful for the treatment of scar alopecia after craniotomy. Our results suggest that the 1-year postoperative hair density should exceed 20 FU/cm2 to achieve good outcomes.

Keywords

References

  1. Hartley F, Kenyon JH. Experiences in cerebral surgery. Ann Surg 1907;45(04):481-530
  2. Kleinberger AJ, Jumaily J, Spiegel JH. Safety of modified coronal approach with dissection deep to temporalis fascia for facial nerve preservation. Otolaryngol Head Neck Surg 2015;152(04):655-660 https://doi.org/10.1177/0194599814567869
  3. Liu M, Lv K, Li Z, Yang X. Using a modified postauricular hemicoronal incision to manage unilateral zygomaticomaxillary complex fracture. J Craniofac Surg 2019;30(08):e740-e741 https://doi.org/10.1097/SCS.0000000000005825
  4. Zhuang QW, Zhang XP, Wang X, et al. Coronal approach to zygomaticomaxillary complex fractures. Eur Rev Med Pharmacol Sci 2015;19(05):703-711
  5. Gabrielli MA, Monnazzi MS, Gabrielli MF, Hochuli-Vieira E, Pereira-Filho VA, Mendes Dantas MV. Clinical evaluation of the bicoronal flap in the treatment of facial fractures. Retrospective study of 132 patients. J Craniomaxillofac Surg 2012;40(01):51-54 https://doi.org/10.1016/j.jcms.2011.01.008
  6. Kadakia S, Badhey A, Ashai S, Lee TS, Ducic Y. Alopecia following bicoronal incisions. JAMA Facial Plast Surg 2017;19(03):220-224 https://doi.org/10.1001/jamafacial.2016.1741
  7. Kumar VS, Rao NK, Mohan KR, et al. Minimizing complications associated with coronal approach by application of various modifications in surgical technique for treating facial trauma: a prospective study. Natl J Maxillofac Surg 2016;7(01):21-28 https://doi.org/10.4103/0975-5950.196143
  8. Rassman WR, Bernstein RM, McClellan R, Jones R, Worton E, Uyttendaele H. Follicular unit extraction: minimally invasive surgery for hair transplantation. Dermatol Surg 2002;28(08):720-728
  9. Okochi M, Fukushima T, Okochi H, Takita K, Onda M. Donor site of follicular unit excision hair transplantation: the relationship between appearance and actual hair density, and hair diameter. J Plast Surg Hand Surg 2020;54(03):172-176 https://doi.org/10.1080/2000656X.2020.1729778
  10. Sanada Y, Yabuuchi T, Yoshioka H, Kubota H, Kato A. Zigzag skin incision effectively camouflages the scar and alopecia for moyamoya disease: technical note. Neurol Med Chir (Tokyo) 2015;55(03):210-213 https://doi.org/10.2176/nmc.tn.2014-0193
  11. Frodel J-L, Mabrie D. Optimal elective scalp incision design. Otolaryngol Head Neck Surg 1999;121(04):374-377 https://doi.org/10.1016/S0194-5998(99)70223-8
  12. Nitta N, Fukami T, Nozaki K. Electrocautery skin incision for neurosurgery procedures-technical note. Neurol Med Chir (Tokyo) 2011;51(01):88-91 https://doi.org/10.2176/nmc.51.88
  13. Ismail A, Abushouk AI, Elmaraezy A, et al. Cutting electrocautery versus scalpel for surgical incisions: a systematic review and meta-analysis. J Surg Res 2017;220:147-163 https://doi.org/10.1016/j.jss.2017.06.093
  14. Shin H, Shin J, Lee JY. Scarred scalp reconstruction with a rectangular expander. Arch Craniofac Surg 2020;21(03):184-187 https://doi.org/10.7181/acfs.2020.00017
  15. Laitung JK, Brough MD, Orton CI. Scalp expansion flaps. Br J Plast Surg 1986;39(04):542-548 https://doi.org/10.1016/0007-1226(86)90132-3
  16. Sahin B. Reconstruction of large alopecia with old technique: V-YS plasty. Int Wound J 2016;13(05):984-985 https://doi.org/10.1111/iwj.12259
  17. Nelson BR, Stough DB, Gillard M, Stough DB, Johnson TM. The paramedian scalp reduction with posterior Z-plasty. A technique to minimize the "slot" defect. J Dermatol Surg Oncol 1992;18(11):996-998 https://doi.org/10.1111/j.1524-4725.1992.tb02774.x
  18. Yotsuyanagi T, Watanabe Y, Yamashita K, Urushidate S, Yokoi K, Sawada Y. New treatment of a visible linear scar in the scalp: multiple hair-bearing flap technique. Br J Plast Surg 2002;55(04):324-329 https://doi.org/10.1054/bjps.2002.3824
  19. Burm JS, Oh SJ. Prevention and treatment of wide scar and alopecia in the scalp: wedge excision and double relaxation suture. Plast Reconstr Surg 1999;103(04):1143-1149 https://doi.org/10.1097/00006534-199904010-00007
  20. Loganathan E, Sarvajnamurthy S, Gorur D, Suresh DH, Siddaraju MN, Narasimhan RT. Complications of hair restoration surgery: a retrospective analysis. Int J Trichology 2014;6(04):168-172 https://doi.org/10.4103/0974-7753.142861
  21. Salanitri S, Goncalves AJ, Helene A Jr, Lopes FH. Surgical complications in hair transplantation: a series of 533 procedures. Aesthet Surg J 2009;29(01):72-76 https://doi.org/10.1016/j.asj.2008.11.005
  22. Anegawa S, Hayashi T, Torigoe R, Harada K, Araki T, Yoshikawa A. Linear transverse forehead incision for patients with alopecia praematura-technical note. Neurol Med Chir (Tokyo) 1995;35(08):604-606 https://doi.org/10.2176/nmc.35.604
  23. Kasai Y, Igawa H, Abe N, et al. Successful follicular unit extraction hair transplant for bald area after skin graft. J Plast Reconstr Aesthet Surg 2017;13:71-76(open)
  24. Yoo H, Moh J, Park JU. Treatment of postsurgical scalp scar deformity using follicular unit hair transplantation. BioMed Res Int 2019;2019:3423657
  25. Shao H, Hang H, Yunyun J, et al. Follicular unit transplantation for the treatment of secondary cicatricial alopecia. Plast Surg (Oakv) 2014;22(04):249-253 https://doi.org/10.1177/229255031402200403
  26. Farjo B, Farjo N, Williams G. Hair transplantation in burn scar alopecia. Scars Burn Heal 2015;1:2059513115607764
  27. Mohebi P, Tassman WR. Hair restoration in cranial surgery patients. Hair Transplant Int 2018;28:97
  28. Parsley WM, Perez-Meza D. Review of factors affecting the growth and survival of follicular grafts. J Cutan Aesthet Surg 2010;3:69-75
  29. Kischer CW, Shetlar MR, Chvapil M. Hypertrophic scars and keloids: a review and new concept concerning their origin. Scan Electron Microsc 1982;4(Pt 4):1699-1713
  30. Zheng J, Song F, Lu SL, Wang XQ. Dynamic hypoxia in scar tissue during human hypertrophic scar progression. Dermatol Surg 2014;40(05):511-518
  31. Kischer CW. Themicrovesselsin hypertrophic scars, keloids and related lesions: a review. J Submicrosc Cytol Pathol 1992;24(02):281-296
  32. Filippova OV, Afonichev KA, Krasnogorskiy IN, et al. Traumatol. Orthopaed Reconst Surg 2017;5:25-35
  33. Josephitis D, Shapiro R. FUT vs. FUE graft survival: a side-by-side study of 3 patients undergoing a routine 2,000+ graft hair transplantation. Hair Transplant Forum International 2018;28:179-182  https://doi.org/10.33589/28.5.0179