Question:
A patient develops hair alopecia after excision of a scalp lesion and coverage with a split-thickness skin graft (STSG). What is the best treatment to restore hair in the affected area?
A patient develops hair alopecia after excision of a scalp lesion and coverage with a split-thickness skin graft (STSG). What is the best treatment to restore hair in the affected area?
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Tissue expansion takes advantage of the scalp's ability to stretch and generate new skin, making it ideal for defects where local flaps are insufficient due to limited natural laxity.
Hair transplants require a thick, vascularized dermal bed to take, which is absent in an STSG over bone.
Hair transplants require a thick, vascularized dermal bed to take, which is absent in an STSG over bone.
Updated On: Sep 3, 2026
- Tissue expansion
- Hair transplant (follicular unit extraction)
- Local scalp flap
- Secondary STSG
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The Correct Option is A
Solution and Explanation
Concept:
The clinical scenario presents a patient who requires cosmetic restoration of a hair-bearing scalp following reconstruction with a split-thickness skin graft (STSG).
The clinician must select the most reliable reconstructive technique to bring natural hair-bearing skin to the alopecic defect.
Explanation:
• A split-thickness skin graft (STSG) contains only the epidermis and a thin layer of the dermis, meaning it is entirely devoid of hair follicles and adnexal structures.
• Consequently, any area of the scalp reconstructed with an STSG will heal as a permanently bald, alopecic patch.
• Performing a direct hair transplant (such as Follicular Unit Extraction, FUE) into an STSG on the scalp is generally contraindicated.
• The thin STSG bed, especially when resting directly over the calvarium, lacks the robust vascularity and dermal thickness required to nourish and support newly implanted hair follicles, leading to high failure rates.
• Tissue expansion is universally considered the gold standard and best treatment for extensive scalp alopecia.
• This technique involves placing a silicone expander beneath the adjacent, normal hair-bearing scalp and gradually inflating it over weeks.
• This process generates new, well-vascularized, hair-bearing skin that perfectly matches the surrounding scalp in color, texture, and hair density.
• Once adequate tissue is generated, the STSG is excised, and the newly expanded hair-bearing flap is advanced to close the defect seamlessly.
Final Answer:
Tissue expansion is the most effective and reliable treatment to restore hair to an alopecic defect previously covered by an STSG.
The clinical scenario presents a patient who requires cosmetic restoration of a hair-bearing scalp following reconstruction with a split-thickness skin graft (STSG).
The clinician must select the most reliable reconstructive technique to bring natural hair-bearing skin to the alopecic defect.
Explanation:
• A split-thickness skin graft (STSG) contains only the epidermis and a thin layer of the dermis, meaning it is entirely devoid of hair follicles and adnexal structures.
• Consequently, any area of the scalp reconstructed with an STSG will heal as a permanently bald, alopecic patch.
• Performing a direct hair transplant (such as Follicular Unit Extraction, FUE) into an STSG on the scalp is generally contraindicated.
• The thin STSG bed, especially when resting directly over the calvarium, lacks the robust vascularity and dermal thickness required to nourish and support newly implanted hair follicles, leading to high failure rates.
• Tissue expansion is universally considered the gold standard and best treatment for extensive scalp alopecia.
• This technique involves placing a silicone expander beneath the adjacent, normal hair-bearing scalp and gradually inflating it over weeks.
• This process generates new, well-vascularized, hair-bearing skin that perfectly matches the surrounding scalp in color, texture, and hair density.
• Once adequate tissue is generated, the STSG is excised, and the newly expanded hair-bearing flap is advanced to close the defect seamlessly.
Final Answer:
Tissue expansion is the most effective and reliable treatment to restore hair to an alopecic defect previously covered by an STSG.
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