Tissue expanders in post-burn alopecia: with or without galeotomies?

The tissue expansion technique is part of the reconstructive surgeon's armamentarium. It provides donor skin that is an optimal match in terms of skin colour, texture, sensation and hair-bearing characteristics. Tissue expansion of the scalp is one of the methods used for the management of alopecia. This method allows the expansion of normal hair-bearing scalp to cover the area of alopecia. Unfortunately, the tough galeal layer prevents easy and fast expansion of the scalp and increases the rate of expander extrusion. A prospective and retrospective comparative analysis of the use of subgaleal expanders with or without galeotomies to manage post-burn alopecia was conducted in the Burn Unit of the Menofia University Hospital, in the period from September 2010 to November 2014. Thirty expanders in 30 patients with alopecia were included in the study. These constitute the experience of a single surgeon. Twenty expanders were applied to the subgaleal plane without galeotomies and 10 were applied with galeotomies. Indications for scalp expansion were mainly post-burn alopecia and scarring. Complications and failures were recorded. Adding galeotomies to subgaleal tissue expander placement for scalp alopecia decreases the time of expansion, allows a larger amount of fluid to be injected each time without inducing pain, and decreases the rate of expander extrusion. Adding galeotomies to subgaleal tissue expander placement for post-burn alopecia ensures preservation of galeal blood supply for easier and faster expansion of the scalp and fewer expander extrusion complications.