Reconstruction of Scalp Anterior Hairline with Tissue Expansion and Skin Flap

Cutaneous defects involving the frontal region and anterior hairline of the scalp can result from congenital or acquired conditions. The negative esthetic impact can cause disturbances in the psychic and social sphere of the patient, causing problems in interpersonal relationships and in the body image itself. The use of skin expanders is usually effective in this region due to the bone base providing support and stability for its use.

We describe the case of a 64-year-old woman submitted to reconstruction of the anterior hairline of the scalp due to scar sequelae after coronal rhytidoplasty followed by pustular erosive dermatosis. We used tissue expansion (50 mL of saline per week until it reached 300 mL) and advancement flap.

Scalp reconstruction also includes vascularized soft tissue coverage, acceptable cosmetic appearance, and minimal morbidity for the donor area. The correction of scalp scars must obey 2 basic principles: tissue similarity and natural capillary pattern (direction, angle, capillary growth, and proper capillary line design). Tissue expansion and skin flap techniques can successfully correct defects in extensive scarring alopecia such as in the presented case.