Tissue expansion in the correction of burn alopecia: classification and methods of correction

Correction of burn alopecia using tissue expansion has recently gained acceptance. Yet, the technical approach to correction of this problem remains one of trial and error. Between January 1985 and December 1988, 102 children underwent placement of tissue expanders for correction of burn alopecia. Two hundred twenty-two expanders were placed during the 178 operative settings. Mean age was 9.1 +/- 4.3 years (range, 3-17 years). Forty-two patients previously underwent partial excisions or rotation of flaps to reduce or camouflage the initial burn alopecia. A review of our experience has dictated that proper classification of burn alopecia can influence operative planning and is essential for establishing guidelines for the correction of this problem. We have developed a classification scheme that addresses this problem. Patients are classified as type I, uniform alopecia; type II, segmental alopecia; type III, patchy alopecia; and type IV, total alopecia. The role of tissue expansion is reviewed in each group.