Scalp flap surgery is a notable hair restoration technique.

Scalp flap surgery is a notable hair restoration surgery. It involves moving a flap of skin and underlying tissues from one area of the scalp to another.

The surgeon cuts out a section of the scalp where there is no growth of hair and replaces it by a flap of hair-bearing scalp. The size and placement of the flap will be as per the patient’s needs. The scar left after the operation will be hidden by the relocated hair.

Objectives of the surgery

Scalp flap surgery aims to repair a non-traumatic cosmetic defect. It also repairs a traumatic injury site and restores its functionality and cosmetic appearance. Another objective of scalp flap surgery is repairing a skin defect resulted by congenital malformation.

Pedicle flaps and free flaps

Both the cosmetic and reconstructive scalp flap surgery uses two types of flaps - pedicle flaps and free flaps. Pedicle flaps are surgically removed from the donor site and transferred to the recipient site with an attached pedicle of tissues. This pedicle of tissues contains the flap’s artery-vein blood supply along with the flap tissues.

The transfer of artery-vein blood supply along with the flap boosts the survival and health of the transferred tissue. Pedicle flaps are most often used for cosmetic hair restoration.

Free flaps are transferred from the donor site to the recipient site without any attached pedicle. But it must contain arteries and veins reattached to blood vessels at the recipient site by micro vascular surgery. These flaps are regularly used in reconstructive surgery when local skin is insufficient to raise a pedicle flap to cover a defect.

The recent years have seen free flaps being used for cosmetic hair restoration. It has been used for this purpose by skilled hair restoration specialists.

Patients with exclusively frontal baldness are good candidates for this hair transplant procedure. However, many surgeons think that this surgical method is not the best treatment for frontal baldness on the head. In scalp flap surgery the rotation of one flap or multiple flaps from the hair bearing donor area of the scalp to the bald area provides complete coverage of hair. Narrow gaps between transferred flaps may need touch-up.

Side effects

Possible side effects of scalp flap surgery are the following:

• Blood supply failure to the flap due to “kinking” or pressure on the flap’s blood supply that can result in partial or total loss of the flap.
• Nerve transaction during surgery that can cause loss of feeling over all or part of the scalp.
• Scarring at donor or recipient sites.
• Permanent hair loss at donor sites.

Advantages

There are many advantages of scalp expansion technique used in the scalp flap surgery.These advantages include the following –

• Excellent frontal scalp coverage
• Natural frontal hairline
• Excellent hair placement in temporal areas
• Good hair direction
• Avoidance of hair pattern distortion

There have been a lot of advancement in the field of plastic surgery in recent years and surgeons combine scalp flap and scalp reduction surgery for better hair coverage of the crown on the scalp.