Surgical management of the burned scalp.

Alopecia from scalp burns can present psychological problems. Reconstructive surgery with rotating hair-bearing skin flaps has been useful in the rehabilitation of these patients. In many patients, one flap shift can establish an acceptable hair line. In extensive cases, multiple operations are necessary, including fractional excision of small burns that have been skin-grafted or fractional excision of the donor site when large hair flaps were rotated. It is remarkable how the occipital flap can reach the forehead by a series of transfers without delay, using a rotation of 90 to 180 degrees. Worthen presented an interesting case of revascularization of the skull in a victim of an electrical burn. In conclusion, scalding hot liquids accidentally spilled on the young child's scalp will produce a deep burn with loss of hair. Small areas of alopecia that are skin-grafted can be handled by staged fractional excision. The hair line can be reestablished in larger areas of alopecia by a series of operative procedures that require years to accomplish. When the periosteum of the skull is affected, resection of the outer table of bone and skin grafting will expedite wound healing.