Question:
Parent’s request for a recommendation for a child burn victim.
Answer:
I wanted to write you directly to tell you a bit about the plan with Amy. She has lost approximately 50% of her scalp, which will be replaced by her expanded remaining scalp. The expansion will be accomplished by the surgical insertion into the remaining hair bearing scalp of likely two tissue expanders- deflated surgical balloons- that over the span of approximately 2 to 3 months will be gradually filled with saline in order to stretch out the scalp, then allowing during a second surgical procedure the removal of as much scarred scalp as possible with its replacement by advancing the expanded scalp. Essentially the goal is to remove as much as 60% of the scarred scalp in a single procedure – it will not be possible to remove all of it- which with some creative styling, will permit her to have a much more normal appearance with at least some hair on the upper and posterior aspect of that side of the burned scalp.
These reconstructive procedures I perform with some regularity, most of them on teenagers and adults. In particular, my background as a facial plastic and reconstructive surgeon, with my specialization in surgical hair restoration (hair transplantation) provides me with the ability to combine various treatments to restore hair, using combinations of hair transplantation, flap surgery, and tissue expansion. Just this week I removed the expanders from a woman who lost approximately 20% of her scalp the result of cancer surgery. There are specific challenges working with young children, as the anatomy is more “delicate”, with smaller room for error, plus the importance of earning both the patient’s and parents’ trust to provide for a positive experience.
I welcome any questions you may have. Hopefully we will have the opportunity to meet.
Posted by Jeffrey S. Epstein, MD, FACS
