Reconstruction of large alopecia with old technique: V‐Y‐S plasty

Abstract

Treatment of alopecia following burns, trauma or tumour surgery is challenging. Local flaps for small or medium sized defects and tissue expansion for larger defects is the common approach. Tissue expansion is a two‐stage procedure and the inflation process causes difficulty for patients. V‐Y‐S plasty is safe and one‐stage method of tissue reconstruction for scalp, face and other parts of the body. We performed this method safely for very large alopecia reconstructions in the scalp.

Introduction

Scalp has the function of protecting the cranium and brain; presence of hair follicles gives it a unique nature. Trauma, tumour surgery and burn injury may cause scalp defects and alopecia. Hair restoration after full‐ or partial‐thickness scalp injury is complicated and several options are available 1. Tissue expansion and flaps are the chief methods and hair transplant should be considered in available patients 2, 3. Tissue expansion was reported by Neumann in 1957. This method has two stages and longer recovery time is required. V‐Y‐S plasty was first reported in 1974 and it is a simpler method 4. We performed V‐Y‐S plasty procedure successfully for alopecia treatment.

Case report

A 22‐year‐old male patient was admitted to the clinic with alopecia in his vertex region from left to right following burn injury. Dimension of alopecia area was 9 × 6 × 4 cm². The skin of the scar tissue was very thin. After reading Demir's paper, we decided to perform one‐stage V‐Y‐S plasty for reconstruction 5. Under general anaesthesia, unhealthy skin was excised and defect was closed. A hemovac drain was used. There was no flap necrosis or any other complications (Figure 1).

Figure 1.

Preoperative and postoperative views.

Technique

The flaps were taken from the area near the defect. The base of the triangle flaps was equal to the defect size. The long axis of the triangles was planned to be about two times the base. Full‐thickness excision was performed. Flaps were elevated in subgaleal plane. One side of one triangle was totally incised to the subgaleal plane, and a short back cut was made to the apex on its other side. Scalp undermining was performed for mobility. A triangular flap was created based on one partially intact side. The other triangle was created following the same method but incisions were reversed. Careful and meticulous haemostasis was performed. Flaps were rotated 45° and advanced towards each other, and their opposing margins were sutured together. Back cuts were closed primarily (Figure 2).

Figure 2.

Surgical technique.

Discussion

Scalp is different from the skin in other parts of the body. Hair‐bearing characteristic makes reconstruction difficult. Primary closure is possible only for very small sized defects. Partial‐thickness defects may be covered with skin graft. This method has poor cosmetic result and it should be a temporary option. Tissue expansion is another option. Large and medium‐sized reconstructions can be performed with this method but two‐stage procedure is required. Local flaps such as banana‐peel, rhombic, bilobed flaps may cover medium‐sized defects. Larger sized scalp reconstructions are difficult 1, 2, 5.

Argamaso reported V‐Y‐S plasty in 1974 for the repair of round skin defects. The technique has been used for defects of the medial canthal area and other parts of the face. Demir et al. used this method in 22 patients for scalp reconstruction. The mean size of scalp defects was 4·5 × 5 cm² with a range of 3·5 × 4 cm² to 6 × 6·5 cm² 4, 5. We performed V‐Y‐S plasty for larger defects. This technique provides an adequate hair‐bearing scalp with good colour and superior tissue match. Other advantages were no dog‐ear formation, pin‐cushioning or distortion. We find this method to be superior and a safe alternative for medium or large‐sized scalp defect or alopecia reconstruction.