DR. EPSTEIN: This is Dr. Epstein. I am here with an unusual case today, David, who hails from north Florida.
David is 34 years old now. When he was two years old he experienced a scalp burn. He lost around 50% of his scalp. Between the ages of 5 and 11 he underwent at least 6 or 7 procedures to reconstruct his scalp. It has done a pretty good job and basically he has some hair coverage.
What he does not like, and I understand this, is that he has still a fair amount of scarring up here. You can see along this side as well.
What he basically has undergone is tissue expansion on this side and they brought this tissue expanded flap forward but it still did not make it all the way. They also went ahead and did some type of flap, like a temporal parietal flap or a Juri flap from here and rotated around but he has this divergent direction of hair growth. He has some scarring still here. Lastly on this side he had some type of advancement done here as well on this peninsula but obviously it is not complete.
What I have explained to David is that what is really good in his situation is his donor hair is like top 10%. He has really good hair with which to work. We just have to figure out how we can move it from here up to here.
We have come up with a plan with what we are going to do. Because he has a lot of scarring here, we do not feel that the hair grafts are going to have a very good chance of growing here plus it is scarred skin and is never going to look good. We are going to do another cycle of tissue expansion. We are actually going to put two balloons in, that is I anticipate two balloons. One balloon is going to go up here and it is going to blow it up so this area is all stretched out. What that will do is permit me to bring in this whole flap forward, cut out all the scar tissue probably up to here.
What we are going to do on this side is we are going to expand this area back here even though he has a scar there which will stretch out a little bit but at least we will get this and we will bring this forward so we get this down to like here.
Posted by Jeffrey Epstein, MD, FACS
