Alopecia Excision and Repair

Patient is first marked with an ellipse around the area to be excised and two parabolic lines offset from each other and approximately the diameter of the area to be excised. 0.5% Lidocaine with epinephrine is then injected into the area, not only to anesthetize the area but also to help hydro-dissect in the loose areolar plane. The area of alopecia is then cut with a 15-blade scalpel and subsequently dissected away. The previously planned flaps are then cut with a 15-blade. Using a combination of blunt scissor technique and periosteal elevator #9 an area is dissected that is sufficient to mobilize the flaps into place. After sufficient mobilization and hemostasis is completed the flaps are stapled into place to help guide placement of the sutures. The tips of the flaps are left free and tucked under the opposing skin to help promote vascularization and prevent necrosis. 3-0 Vicryl buried galeal sutures are used and the skin and dermis is closed with 4-0 or 5-0 chromic suture in a matress fashion.

Defects in the parietotemporal regions of the scalp usually 5 cm or less. Congenital alopecia, Cicatricial alopecia, Alopecia areata, cosmesis.

Patient desire, recent systemic chemotherapy or radiation

#9 Periosteal Elevators

General anesthesia, head wrap exposing area of alopecia and a substantial margin. Shave the area immediately surrounding the defect. Mark the skin and prep with betadine. Inject Lidocaine and epinephrine and allow time for vasoconstriction

History & Physical exam, CBC, Coagulation Profile, Metabolic Panel, Anesthesia ASA Categorization

Differentiate shaved skin from alopecia with absent follicles. Distinguish the dissection plane of loose areolar tissue between the periosteum and aponeurosis.

Bleeding, infection, seroma, scar formation from closure, necrosis at the tips of the flap

Bleeding, infection, seroma, scar formation from closure, necrosis at the tips of the flap

Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an Algorithmic approach. Plastic Reconstruction Surg. 2005;116:54. http://dx.doi.org/10.1097/01.prs.0000179188.25019.6c