Scalp soft tissue expansion combined with follicular unit extraction for postburn cicatricial alopecia: a single center experience of 48 patients

Purpose: This case series aimed to evaluate the efficacy of a composite reconstructive surgery combining scalp soft tissue expansion (SSTE) with follicular unit extraction (FUE) in the treatment of post-burn cicatricial alopecia. Methods: From June 2006 to July 2010, 48 patients (32 males and 16 females, mean age 23 years, including 3 pediatric patients) with postburn cicatricial alopecia who were treated by scalp alopecia reconstruction (SSTE and FUE) were enrolled. The procedure was divided into three stages. Stage I involves the insertion of the expander into the scalp and its expansion to at least 2 fold of the original scarred area. In stage II, the original scarred tissues were excised and local flaps transfer repair (LFTR) was conducted to cover the defect. In stage III, FUE was applied to cover the unmulched scars, hairline or the residual defect. Results: A total of 38 patients participated in the stage III of the scalp alopecia reconstruction. During the follow-up of 2-5 years, the outcomes were described as excellent in 23 patients (60.5%) and good in 14 patients (36.8%), whereas one patient (2.6%) was lost to followed-up. Three patients (6.25%) developed complications in scalp soft tissues expansion, including 1 case of infection and 2 cases of wound dehiscence. Conclusion: The combination of SSTE and FUE was a powerful and effective approach for post-burn cicatricial alopecia.