posted by E. Antonio Mangubat, MD on October 3, 2014
Flap surgery is a hair restoration treatment for baldness. It involves moving a “flap” of skin from one area of the body to another. Scalp flap surgery has an important but limited role in hair restoration.
Patient Selection
Scalp flap surgery moves hair-bearing scalp to the bald area providing instantaneous hair coverage. Narrow gaps between transferred flaps may require some “touch-up” by hair transplantation or scalp reduction later.
More extensively those using this treatment for baldness as a hair restoration option may benefit substantially from scalp flap surgery with proper preoperative planning and when the procedure is performed by a skilled, experienced hair surgeon.
Scalp Surgery: Flaps Facts
Pedicle Flaps
Tissue transfer of from one site to another is usually done in a series of procedures. These procedures include planning and marking the flap(s) and recipient site(s), incising the flap, raising and transferring the flap with its attached blood vessels and closing the wound at the donor site.
Planning for flap transfer to a bald area must include a consideration of hair direction in the transferred flap. Adjustments in hair styling may be all that is needed to disguise small differences in hair growth direction and narrow bands of thin hair growth between flaps.
Discuss the complications of scalp flap surgery with your hair restoration surgeon when considering any surgery.
Microsurgical Free Flaps
The “free” flap is surgically removed from the donor site and transferred to the recipient site without any attached blood supply.
Results have shown use of microsurgical flaps can eliminate the complications of distorted hair pattern and inconsistent hair density, however, microsurgery is an advanced technique in cosmetic and reconstructive surgery that requires great skill, training and experience. Most physician hair restoration specialists do not have this training and would not recommend use of microsurgical flaps for cosmetic hair restoration.
Scalp Expansion
Expansion of hair-bearing scalp by the technique of scalp expansion can also a scalp flap technique. The expanded hair-bearing scalp makes more hair-bearing scalp available for a variety of flaps useful in the treatment of alopecia. Several procedures are necessary to achieve a final result: (1) placement of the expander under the scalp, (2) inflation of the expander over a period of weeks, (3) removal of the expander, (4) creation and transfer of flap(s) from donor to recipient area, and (4) closure of the wound at the donor site. Patients with an extensive area of baldness may require a second expansion series to achieve complete coverage.
Like all advanced procedures, the expansion/flap procedure should be performed only by skilled and experienced surgeons who have training in this this specific technique.