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Skin harvesting on the scalp in children: utopia or reality
Insights
Scalp skin harvesting in children is a safe and effective method for split-skin grafting, offering rapid healing and minimal scarring. This approach is recommended as a primary option due to its significant advantages over potential complications.
Area of Science:
- Dermatology
- Pediatric Surgery
- Wound Healing
Background:
- The scalp is a frequently utilized donor site for split-skin grafts in pediatric patients.
- Systematic use of the scalp for skin harvesting in children has been employed since 1990.
Purpose of the Study:
- To analyze the outcomes, benefits, drawbacks, and complications associated with using the scalp as a donor site for split-skin grafts in children.
- To evaluate the efficacy and safety of scalp skin harvesting in pediatric burn and lesion management.
Main Methods:
- A retrospective and prospective study involving 43 pediatric patients (9 months to 15 years 6 months).
- Grafting procedures for burns or other lesions, with grafted surface areas ranging from 0.5% to 35% of total body surface (TBS).
- Scalp preparation involved marking hair limits, shaving, disinfection, saline infiltration, and harvesting with an electric dermatome; donor sites were covered with adrenaline-soaked sponges.
Main Results:
- Scalp healing was complete within 7–14 days (mean 9.5 days).
- No mortality or infections were reported; hypertrophic scars and retractions were absent.
- Three children experienced alopecia, with one requiring further surgery; hair sparseness was noted in one case after multiple harvests.
Conclusions:
- Scalp skin harvesting is recommended as a first-choice method in pediatric split-skin grafting.
- The rapid epithelialization and absence of visible scars are significant advantages that outweigh potential risks.
- This technique offers a favorable risk-benefit profile for pediatric reconstructive surgery.
Unlabelled:
Since 1990 we have used systematically the scalp as donor site for split skin graft in children. The aim of this retrospective and prospective study is to analyse the results, advantages, disadvantages, complications and problems of this method.
Material And Methods:
The series includes 43 children, age: 9 months to 15 years 6 months (mean age 5 years 9 months) who presented burns or other lesions. The surface to be grafted was 0.5% to 35% of the body surface (mean surface: 6.6% TBS). The follow-up was 25 to 1086 days (mean: 304 days). The donor site is prepared by marking of the hair-limit, shaving, disinfection and infiltration with normal saline under the galea of the surface to be harvested. Skin harvesting is done with an electrical dermatome. The donor site is covered with sponges soaked in adrenaline (1/500,000).
Results:
1 child required harvesting twice in 2 weeks, another one 3 times in 3 months. All the other children required only one procedure. 4 children needed a meshing of the graft. They required also harvesting from other donor sites. The surface to be grafted represented more than 15% TBS. 5 children with a surface to be grafted between 10 and 15% TBS could be covered in one session, without meshing, taking only the scalp. The healing of the scalp was complete after 7 to 14 days (mean: 9.5 days). There was no mortality in our series. We were not confronted with any infection. No hypertrophic scars or retractions were encountered. 3 children presented zones of alopecia, one had sequelae and needed two surgical procedures. The two other cases were minor cases and did not require further treatment. A certain sparseness of hair was noticed in a black girl, after the third harvesting. The blood losses were estimated as a total and have also to be attributed to the tangential excision of the burn area.
Conclusion:
Skin harvesting from the scalp in children can be recommended as first choice. The advantages, especially the rapid epithelialisation and the lack of visible scars, overcome the problems and the risks.