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International Journal of Cosmetic... Nov 2021We have conducted a thorough review of the literature to assess the evidence for supporting a cause-and-effect linkage between scalp condition and resultant hair... (Review)
Review
We have conducted a thorough review of the literature to assess the evidence for supporting a cause-and-effect linkage between scalp condition and resultant hair condition. Over 20 epidemiological studies have been published covering a wide range of abnormal scalp conditions in which consequent impacts to the hair have been documented. A treatment study was conducted to demonstrate not only that impaired scalp condition led to impaired hair quality but that the impacts to hair are reversible upon normalization of the scalp condition. A proposed explanation involves the impact of scalp oxidative stress, which is part of the etiology of these scalp conditions as well as normal aging, in interfering with the normal keratinization of the pre-emergent hair cuticle. This perturbed cuticle impedes normal fiber anchorage and emerges more brittle and fragile than normal cuticle leading to accelerated physical degradation, mirroring the effects of chronological aging of the hair fiber. The consequences of the rapid cuticle degradation result in hair that is more vulnerable to mechanical insults and compromised overall quality.
Topics: Aging; Hair; Hair Diseases; Humans; Oxidative Stress; Scalp; Skin Diseases
PubMed: 33932025
DOI: 10.1111/ics.12708 -
Journal of Reconstructive Microsurgery Sep 2022Microsurgical scalp reconstruction has evolved immensely in the last half-century. The core concepts of microsurgical scalp reconstruction have always been to... (Review)
Review
BACKGROUND
Microsurgical scalp reconstruction has evolved immensely in the last half-century. The core concepts of microsurgical scalp reconstruction have always been to transfer soft tissue of a sufficient quality to within the defect while minimizing donor site morbidity. Refinements in scalp reconstruction consist of both improvement in reducing donor site morbidity and enhancing recipient site contour and balance. Furthermore, technical advancements and the vast experience within our field have allowed for preoperative evaluation of recipient vessels that are more favorable in proximity to the scalp.
METHODS
In this review, we aim to describe the contemporary approach to microsurgical scalp reconstruction. This is to include the indications of choosing free flaps as well as how to select the ideal flap based on patient-oriented factors. The need for cranioplasty, recipient vessel selection, operative technique, and reoperations is also reviewed. In addition, our considerations and the nuances within each category are also described.
SUMMARY
Scalp reconstructions involve the fundamental tenants of plastic surgery and demand application of these principles to each case on an individual basis and a successful reconstruction must consider all aspects, with backup options at the ready. Two workhorse free flaps, the anterolateral thigh perforator and latissimus dorsi muscles flaps, serve a primary role in the contemporary approach to microsurgical scalp reconstruction.
CONCLUSION
We hope this review can lay the foundation for which future plastic surgeons may continue to build and advance the approach to complex microsurgical scalp reconstruction.
Topics: Free Tissue Flaps; Humans; Plastic Surgery Procedures; Scalp; Superficial Back Muscles; Veins
PubMed: 34921371
DOI: 10.1055/s-0041-1740131 -
The Journal of Craniofacial SurgeryScalp avulsions are rare but can be quite morbid clinical manifestations. Pediatric patients are different from adults as they have not completed their physical, sexual,...
Scalp avulsions are rare but can be quite morbid clinical manifestations. Pediatric patients are different from adults as they have not completed their physical, sexual, educational, or psychosocial development. Therefore, the devastation of a failed scalp replantation is much greater on these individuals, their whole future lives, and families. We present 2 consecutive pediatric cases retrospectively with the youngest successful replanted patient in Turkey and describe technical tips according to our experience.
Topics: Adult; Humans; Child; Scalp; Retrospective Studies; Microsurgery; Anastomosis, Surgical; Amputation, Traumatic
PubMed: 35894477
DOI: 10.1097/SCS.0000000000008860 -
Plastic and Reconstructive Surgery Sep 2022Electrical injuries of the scalp are a frequent occurrence in developing countries. Burns can be contact or conductive and result in extensive tissue damage. The authors...
BACKGROUND
Electrical injuries of the scalp are a frequent occurrence in developing countries. Burns can be contact or conductive and result in extensive tissue damage. The authors present their experience with treatment of scalp and calvarial electrical injuries and propose a management algorithm.
METHODS
This was a retrospective cohort study comprising all patients with electrical injuries of the scalp treated at the authors' center between January of 2010 and December of 2016. Noncontrast computed tomography scans were obtained to assess viability of the calvarium in patients who presented more than 2 weeks after injury. Single-stage débridement and reconstruction were performed. All nonviable soft tissue and bone was removed. Soft-tissue reconstruction was performed with skin grafts, local scalp flaps, pedicled trapezius flaps, and free flaps (anterolateral thigh, latissimus dorsi, and scapular). Cranioplasty was performed in a delayed manner with autologous bone grafts.
RESULTS
Over a 7-year period, a total of 52 patients underwent scalp reconstruction for high-voltage (44 patients) and low-voltage (eight patients) electrical injury. All patients underwent successful soft-tissue reconstruction. Osteomyelitis with draining sinuses developed in three patients; these patients underwent flap re-elevation and bone débridement, which resulted in a healed wound and stable reconstruction. Cranioplasty was performed with split calvarial grafts in two patients and split rib grafts in four patients. One patient underwent scalp tissue expansion for hair restoration.
CONCLUSION
The authors propose an algorithm for reconstruction of electrical injuries of the scalp. Thorough débridement of the calvarium is the most important determinant of a successful outcome.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Algorithms; Free Tissue Flaps; Humans; Plastic Surgery Procedures; Retrospective Studies; Scalp; Skin Transplantation; Soft Tissue Injuries; Treatment Outcome
PubMed: 35791281
DOI: 10.1097/PRS.0000000000009452 -
Magnetic Resonance in Medical Sciences... Jun 2021Although androgenetic alopecia (AGA) is a common cause of hair loss, little is known regarding the magnetic resonance imaging (MRI) of the AGA or scalp. This study aimed...
PURPOSE
Although androgenetic alopecia (AGA) is a common cause of hair loss, little is known regarding the magnetic resonance imaging (MRI) of the AGA or scalp. This study aimed to analyze whether MRI for hair and scalp (MRH) can evaluate anatomical changes in the scalp caused by AGA.
METHODS
Twenty-seven volunteers were graded for the severity of AGA using the Hamilton-Norwood Scale (HNS), commonly used classification system. All subjects underwent MRH; two radiologists independently analyzed the images. As a quantitative measurement, the number of hair follicles was analyzed and compared with the HNS. As a qualitative analysis, each MRH scan was visually graded in terms of the severity of alopecia, using a 4-point MR severity score. The scores were compared with the HNS.
RESULTS
The volunteers were divided into two groups of 12 and 15 males without and with AGA at their vertex, respectively. Inter-observer agreements for the hair count and the MR severity score were excellent. The mean hair count on MRI in the normal group was significantly higher than that in the AGA group (P < 10). The MR severity score in the AGA group was significantly more severe than that in the control group (P < 10). In terms of the presence or absence of thinning hair, the MR severity score was consistent with the HNS determined by a plastic surgeon in 96% of cases. MR severity scores of clinically moderate AGA cases were significantly lower than those of severe cases (P = 0.022).
CONCLUSION
MRH could depict scalp anatomy showing a clear difference between AGA and normal scalps, in both hair count and subjective visual assessment. The MR severity score was in good agreement with the clinical stages by HNS. The results support the potential of MRH as a promising imaging technique for analyzing healthy and pathological scalps.
Topics: Adult; Alopecia; Hair; Hair Follicle; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Scalp
PubMed: 32378681
DOI: 10.2463/mrms.mp.2020-0026 -
Cleveland Clinic Journal of Medicine Sep 2023
Topics: Humans; Scalp; Genitalia; Skin Diseases
PubMed: 37657837
DOI: 10.3949/ccjm.90a.22100 -
Journal of Wound Care Feb 2024This article aims to present a narrative review of current literature about the anatomical characteristics of the scalp as well as current practices in the management of... (Review)
Review
OBJECTIVE
This article aims to present a narrative review of current literature about the anatomical characteristics of the scalp as well as current practices in the management of surgical, traumatic and pressure injuries in the scalp, which are common in neurosurgery practice.
METHOD
We searched PubMed for publications and book chapters in English from 2011 to 2021. We also included commonly referenced papers that we considered relevant to the subject with publication before these dates. We used the search terms 'laceration,' and/or 'neurosurgery' and/or, 'pressure injury,' and/or 'craniotomy,' and/or 'surgical incision' in combination with 'scalp,' and/or 'wound care.' We also searched the reference lists of publications identified by the search strategy and selected those that we judged relevant.
RESULTS
We pre-selected 52 articles that covered various aspects of anatomy, pathophysiology, scalp wound management, or general wound care that we considered applied to the anatomical region of our interest. After abstract review, we selected 34 articles that met our search criteria and were included in our review.
CONCLUSION
There is limited evidence regarding classification and care of scalp wounds. As a result, many of the current practices for scalp wound management are based on evidence derived from studies involving different anatomical regions, not considering its particular anatomy, vasculature and microbiome. Further research is needed for more comprehensive and effective protocols for the management of scalp injuries. However, this present review proposes responses to the identified gaps concerning the management of scalp wounds.
Topics: Humans; Scalp; Wound Healing; Surgical Wound Infection; Surgical Wound; Craniotomy
PubMed: 38329834
DOI: 10.12968/jowc.2024.33.2.127 -
Journal of Gynecology Obstetrics and... Apr 2021Assess the discordance between scalp pH and lactates performed from the same sample during labor.
OBJECTIVE
Assess the discordance between scalp pH and lactates performed from the same sample during labor.
METHOD
This single-center retrospective study included all women with a singleton fetus who had at least one fetal blood sample taken during labor. Some of them had up to seven samples. Scalp pH was the reference parameter for obstetric decision-making. The correlation between the pH and lactates was studied using Pearson coefficient. By categorizing the values as normal, pre-acidosis and acidosis, we were able to estimate agreement with Cohen's kappa coefficient. The frequency of discordance in the categorization and the factors related to it were studied with univariate and multivariable analyses. Cases of severe acidosis at birth (cord pH < 7.00) and cases with acidosis scalp lactates but normal scalp pH were analyzed.
RESULTS
We analyzed 480 samples from 268 fetuses among the 2644 deliveries during the study periode. Fetal blood sampling represented 10 % of deliveries. The scalp pH and lactates results were strongly correlated (r=-0.83), but their agreement was only fair (K = 0.36). In 29.4 % of cases, pH and lactates were discordant. Factors related to discordance were meconium-stained fluid, sampling at full dilation and multiple sampling. Six infants (2.2 %) had severe acidosis at birth. Cases' analyses did not allow to conclude severe acidosis could have been avoided using scalp lactates for obstetric decision-making.
CONCLUSION
For more than a quarter of the samples, results were discordant between scalp pH and lactates, especially when cervix was full dilated and when the amniotic fluid was meconium-stained. A randomized controlled trial comparing the relevance of each parameter according to the obstetrical situation would be necessary.
Topics: Acidosis, Lactic; Adult; Amniotic Fluid; Female; Fetal Blood; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor Stage, Second; Labor, Obstetric; Lactic Acid; Meconium; Pregnancy; Retrospective Studies; Scalp
PubMed: 33130281
DOI: 10.1016/j.jogoh.2020.101964 -
Journal of Drugs in Dermatology : JDD Jul 2023Alopecia is one of the most common dermatologic conditions affecting black patients, with a significantly negative impact on quality of life.1,2 Timely and accurate...
Alopecia is one of the most common dermatologic conditions affecting black patients, with a significantly negative impact on quality of life.1,2 Timely and accurate diagnosis is therefore critical in order to reverse or halt progression of disease.3 Unfortunately, lack of representation of skin of color (SOC) patients in the current literature may contribute to misdiagnosis as providers may be unfamiliar with the clinical spectrum of alopecia presenting in darker scalps.4 Some scarring alopecia subtypes such as Central Centrifugal Cicatricial Alopecia (CCCA) are more prevalent in certain racial groups. However, focusing solely on patient demographics and gross clinical findings may obscure accurate diagnoses. To distinguish alopecia findings in Black patients, a dedicated approach using a combination of clinical exam findings and patient history, along with trichoscopy and biopsy, is essential to prevent misdiagnosis and improve clinical and diagnostic outcomes. We present three cases of alopecia in patients of color which the initial suspected clinical diagnosis did not correspond with trichoscopic and biopsy results. We challenge clinicians to reexamine their biases and fully evaluate patients of color with alopecia. An examination should include a thorough history, clinical examination, trichoscopy, and potentially a biopsy, particularly when findings do not correlate. Our cases highlight the challenges and disparities that exist in diagnosis of alopecia in Black patients. We emphasize the need for continued research regarding alopecia in skin of color and the importance of a complete workup for alopecia to improve diagnostic outcomes.Balazic E, Axler E, Nwankwo C, et al. Minimizing bias in alopecia diagnosis in skin of color patients. J Drugs Dermatol. 2023;22(7):703-705. doi:10.36849/JDD.7117.  .
Topics: Humans; Alopecia; Quality of Life; Scalp; Black or African American; Bias
PubMed: 37410034
DOI: 10.36849/JDD.7117 -
Annals of Plastic Surgery Apr 2023Avulsion of the scalp is a rare destructive event worldwide. Before the emergence of microsurgery, skin transplantation, flap transplantation, greater omentum...
BACKGROUND
Avulsion of the scalp is a rare destructive event worldwide. Before the emergence of microsurgery, skin transplantation, flap transplantation, greater omentum transplantation, and other methods were once widely used. However, replantation offers the optimum reconstruction.
METHODS
Six cases of complete avulsion injury of a large scalp treated from May 2017 to May 2020 were retrospectively analyzed. Under the microsurgery technology, the wound was cleaned and explored, and the appropriate arteriovenous anastomosis was selected. Preoperative blood preparation and skin preparation were actively performed. Postoperative strict nursing and observation of the blood supply of replanted scalp were performed. Regular outpatient follow-up after discharge was performed.
RESULTS
Replantation was successful in 5 cases and failed in 1 case, and in 1 case the occipital scalp (approximately 10% of the scalp area) died and crusted 2 months after the operation. After 6 to 24 months of follow-up, all patients were satisfied with the reconstructed appearance.
CONCLUSIONS
Superb microsurgical technique and more detailed anatomical knowledge are the key conditions for successful complete scalp avulsion replantation. Compared with other methods, successful replantation can achieve the best aesthetic and functional results.
Topics: Humans; Amputation, Traumatic; Microsurgery; Replantation; Retrospective Studies; Scalp; Surgical Flaps
PubMed: 36752491
DOI: 10.1097/SAP.0000000000003468