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At least 19 recordsLinked to original sources
PubMed1994

Circumferential scalp reduction. The application of the principles of extensive scalp-lifting for the improvement of scalp reduction surgery.

BACKGROUND. Conventional scalp reduction techniques involve the undermining of bald skin, inducing the problems of stretch-back and slot formation in the majority of patients. Conversely, extensive scalp-lifting, a relatively new technique, never undermines bald skin; therefore, the problem of stretch-back is minimal and slot formation is reduced. This procedure, however, is more intricate, owing to the undermining down to the hairline of the nape. Because not all cosmetic hair replacement surgeons desire to perform this more intricate surgery, the author takes many of the principles of scalp-lifting and applies them to the scalp reduction procedure. With the application of these principles, many of the problems of scalp reduction surgery are significantly reduced and other aesthetic aspects improved.

Alopecia↗
PubMed1997

Intrapartum assessment of fetal well-being: a comparison of scalp stimulation with scalp blood pH sampling.

OBJECTIVE: To determine whether the need for fetal scalp pH sampling is decreased by the scalp stimulation test and whether redefinition of reactivity and presence of variability further decrease the need for scalp pH sampling. METHODS: One hundred eight women with fetal heart rate (FHR) patterns suggestive of acidosis underwent fetal scalp blood pH evaluations. Digital scalp stimulation was performed for 15 seconds 1-2 minutes before pH sampling. The study group was subdivided based on reactivity to scalp stimulation and scalp puncture and was correlated with pH values. Reactivity was defined as an acceleration of 15 beats per minute or more lasting at least 15 seconds and redefined as an acceleration of 10 beats per minute or more lasting at least 10 seconds. Nonreactive responses were subdivided based on FHR variability preceding the scalp stimulation and were correlated with pH values. Fisher exact test was used for analysis. RESULTS: All 51 instances of acceleration of 15 beats per minute or more lasting at least 15 seconds following scalp stimulation had a scalp pH of 7.20 or more. Using an acceleration of 10 beats per minute or more lasting at least 10 seconds, seven more reactive responses were obtained after scalp stimulation, all with pH of 7.20 or more. The 15 instances in which the pH was less than 7.20 were nonreactive irrespective of the definition of reactivity (P < .001). Twenty-one of the 50 instances of nonreactive responses (reactive response: acceleration of 10 beats per minute or more lasting at least 10 seconds) had positive variability. Only two of these 21 (9.5%) instances compared to 13 of the 29 (45%) instances with negative variability had pH less than 7.20 (P < .007). CONCLUSIONS: The scalp stimulation test could decrease the need for fetal scalp blood sampling by 47%. Redefinition of reactivity could decrease the need for scalp sampling by 54%. In addition, assessment of FHR variability before scalp stimulation could decrease further the need for scalp blood sampling by 73%.

Acidosis↗
PubMed2005

[Value of fetal scalp lactate sampling during labour: a comparative study with scalp pH].

OBJECTIVE: To evaluate the validity and the feasibility of fetal scalp lactate sampling during labour in the assessment of non reassuring fetal status. PATIENTS AND METHOD: A prospective observational study was conducted on 129 fetal scalp blood samplings. Scalp lactate measurements were compared to scalp pH (gold standard procedure), neonatal cord blood gas (pH and lactates) and Apgar score. Pathological values taken were for scalp lactates>5 mmol/l, scalp pH<7.20, cord arterial pH<7.10, cord arterial lactates>6,35 mmol/l, and Apgar score<7 at one and five minutes. All measurements were performed using the Rapid Lab 860 device from Bayer. RESULTS: Scalp lactate correlated significantly with scalp pH (R=-0.54, P=0.001), with umbilical artery pH (R=-0.46, P=0,01), with umbilical artery lactate (P=0.49, P=0.01), but with neither Apgar score at one minute (R=-0.21, ns) nor at 5 minutes (R=-0.11, ns). Scalp lactate at a cut-off value of 5 mmol/l had the same predictive values than scalp pH at 7.20 to predict neonatal acidosis. Sampling failure with scalp lactate was inferior to 1 vs 18% for scalp pH. DISCUSSION AND CONCLUSION: The measurement of lactate in fetal blood scalp seems correlated to the fetal scalp pH. It may be an attractive alternative to pH analysis and a useful tool for monitoring fetal asphyxia, especially with the advent of handheld devices requiring small sample volumes.

Adolescent↗
PubMed1995

New devices for scalp reduction. Intraoperative and prolonged scalp extension.

BACKGROUND: Scalp reduction for male pattern and other extensive, permanent crown-vertex alopecias has been a beneficial, adjuvant procedure in hair replacement surgery and has been augmented by unsightly and sometimes painful intraoperative and chronic scalp expansion techniques. METHODS: Ten patients underwent scalp reduction for male pattern baldness utilizing intraoperative Sure-Closure, a skin-stretching device. Ten patients had Frechet Extenders placed under the scalp during their scalp reductions with subsequent removal 28 days later followed immediately by second reduction procedures. RESULTS: The skin-stretching device, Sure-Closure, allowed the excision of 20%-30% more alopecic scalp during scalp reduction than what would have been possible with scalp reduction alone. The Frechet Extender when combined with a lazy S excision pattern for scalp reduction procedures generated between 25% and 50% more excision of alopecic scalp than with scalp reduction alone. CONCLUSION: Scalp reduction procedures can be more effectively performed with minimal complications and fewer reductions required per patient using either intraoperative scalp extension with the Sure-Closure device or chronic scalp extension with the Frechet Extender.

Alopecia↗
PubMed1987

Scalp heat flux and its relationship to scalp blood pH of the fetus.

A method for directly assessing the metabolic rate of the fetus for optimal management of labor and delivery is still being studied. Since heat, an end product of metabolism, is dissipated from the fetal surface, we measured the heat flux from the fetal scalp and related it to the pH of fetal scalp blood, a measure of metabolism. In 25 human fetuses at risk of intrapartum hypoxia, after the membranes had ruptured and the cervix dilated to greater than 3 cm, we attached a heat flux transducer, a platelet of 2.5 cm diameter and 1 mm thickness, to the fetal scalp and recorded continuously the heat flux from then until delivery. We also obtained one sample of fetal scalp blood in all patients and two such samples in 13 patients for the analysis of pH. We found a significant correlation between heat flux measured immediately before the scalp blood sampling (presampling values) and the pH of fetal scalp blood (r = 0.736; n = 18 presampling values; p less than 0.001). Out of 13 fetuses with two scalp blood samples, the changes in the scalp heat flux paralleled changes in scalp blood pH in 11. We conclude that fetal scalp heat flux is related to the metabolic condition of the fetus. Measuring scalp heat flux during labor could be developed into a noninvasive method for a continuous and more direct assessment of the fetal metabolic rate.

Adult↗
PubMed2002

Transfollicular drug delivery: penetration of drugs through human scalp skin and comparison of penetration between scalp and abdominal skins in vitro.

In order to quantitatively investigate the importance of transfollicular pathway for drug delivery, drug penetration through human scalp skin was investigated using liquid formulations containing lipophilic and hydrophilic drugs in vitro. The penetration pathway for drugs through the scalp skin was examined using fluorescent probes. Additionally, the drug penetration through the scalp skin was compared with that via human abdominal skin to clarify the usefulness of intrafollicular delivery. Lipophilic melatonin (MT) and ketoprofen (KP) showed high permeabilities through the scalp skin, although the flux of KP was much higher. Absorption enhancers, N-methyl-2-pyrrolidone and isopropylmyristate, only slightly increased the fluxes. Hydrophilic fluorouracil (5FU) and acyclovir (ACV) penetrated through the scalp skin with relatively large fluxes. However, there was large variability in the fluxes of these drugs across scalp skin from different sources. When the relationship between the flux and hair follicle density was estimated, there was good correlation between the two (r = 0.651 for MT and r = 0.666 for ACV, P < 0.05). The histologic examination of the scalp skin, following application of the formulation with nile red or sodium fluorescein, indicated that the probes permeated into the junction of the internal and external root sheath of follicles and diffused into the dermis via the outer root sheath at the initial times. The penetration of nile red, a lipophilic probe, via the stratum corneum of scalp skin was later than that via the follicles. The permeation of MT and 5FU through the scalp skin was much higher than that via the abdominal skin, being 27 and 48 times as high as the abdominal skin, respectively. These results indicate that the drug delivery through the scalp skin will offer an available delivery means for drugs, particularly for hydrophilic drugs.

Abdomen↗
PubMed1984

The scalp stimulation test: a clinical alternative to fetal scalp blood sampling.

Intrapartum fetal heart rate response to various scalp stimuli and its correlation with scalp pH was studied in a prospective manner. One hundred fetuses with heart rate tracings judged by the resident responsible for the patient to be suggestive of fetal asphyxia were entered into the study. Each fetus was subjected to firm digital pressure on the head followed by a gentle pinch of the scalp with an atraumatic clamp. Scalp blood sampling was then performed in the usual manner. Response to either of these stimuli by an acceleration of the fetal heart rate of 15 bpm lasting at least 15 seconds was uniformly associated with a scalp blood pH of greater than or equal to 7.19. Fifty-one fetuses so stimulated responded with an acceleration. Of the remaining fetuses, 19 had a scalp pH less than 7.19 and 30 were associated with a pH greater than 7.19. Clinical application of such a scalp stimulation test could, therefore, reduce the necessity for scalp blood sampling by approximately 50% in the presence of a fetal heart rate pattern suggesting acidosis. Such a provocative test may also be very useful with an abnormal fetal heart rate pattern suggestive of acidosis when the cervix is sufficiently dilated to permit scalp blood sampling.

Female↗
PubMed1985

Short-latency scalp somatosensory evoked potentials and central spine to scalp propagation characteristics during peroneal and median nerve stimulation in multiple sclerosis.

Peripheral (cauda-lumbar, wrist-Erb, Erb-cervical) and central (cauda-vertex, cervical-scalp) nervous impulse propagation velocities and times to peroneal and median nerve stimulation were investigated in 34 patients suffering from definite (17 cases), probable (6 cases) and possible (11 cases) forms of multiple sclerosis (MS). In 6 cases short- and intermediate-latency scalp somatosensory evoked potentials to peroneal nerve stimulation were recorded with 'open' (1-5000 Hz, -6 dB) bandpass filters and subsequently digitally filtered through a 'narrow' bandpass (200-5000 Hz, -6 dB). The lumbar response was abnormal in 2.95% of legs, while the Erb response was always within normal limits. The cauda-vertex conduction was altered in 75% of the examined limbs (86.2% definite, 58.3% probable, 63.6% possible MS). Absent scalp responses to peroneal stimulation were often encountered during narrow bandpass recording (54.9%), while a slowed central conduction was less frequent (33.3%). Scalp responses when recorded with open bandpass were always identifiable, being delayed in 3 out of 6 cases. In 5 of these the short-latency wavelets were either absent or showed a prolonged interpeak time even when open filter records were normal. Median nerve SEPs were altered in 60.3% of cases, more frequently because of a delayed scalp response or of a prolonged cervical-scalp conduction time than because of an absent cervical or scalp response. When peroneal and median nerve data were considered together, the rate of abnormality rose to 88.2% of patients. Due to their length, afferent pathways from the lower limb might suffer from a loss of high frequency impulse coding as an early sign of defective impulse propagation.

Adolescent↗
PubMed2003

First successful replantation of face and scalp with single-artery repair: model for face and scalp transplantation.

Successful replantation of the scalp with microanastomosis of a single artery and vein has been reported to produce reliable results. In fact, there have been several reports of scalp replantations based on one-artery and vein repair. There has been a face and scalp replantation reported in the literature, but this was as two separate parts and was based on several arterial and venous repairs. The authors performed the first successful replantation of a face and scalp with repair of a single artery and, of course, two veins. A 21-year-old man presented after his face and scalp were completely severed. The patient's long hair was caught in a conveyor belt at work. The face and scalp underwent replantation, with repair of the right superficial temporal artery with an interposition vein graft. A multiteam approach allowed for minimization of overall ischemic time and simultaneous preparation of the vessels on the patient and amputated part as well as vein graft harvest from the arm. Also critical to the success of the procedure, the small portions of the vessels of the amputated part were sent for frozen section to differentiate artery from vein. Initially, only the right superficial temporal vein was repaired. One week after replantation, the patient returned for treatment of venous congestion of an area to the opposite side of the forehead partial transection, with repair of the left superficial temporal vein, also. This saved the entire part that underwent replantation, and the entire part survived. The face and scalp can undergo replantation based on single-artery repair.

Accidents, Occupational↗
PubMed1997

A comparison of the scalp kinetics in scalp-lifting with and without an intact occipital neurovascular bundle.

BACKGROUND: This paper compares the scalp kinetics of the scalp-lifting procedures with and without an intact occipital neurovascular bundle. OBJECTIVE: The objective of this paper is to perform lateral scalp-lifts and observe if an intact occipital neurovascular bundle hampers the amount of scalp advancement. METHODS: Ten consecutive patients had lateral scalp-lifts performed without severing the occipital neurovascular bundle. Advancements were then measured at three points (mid-posterior, above the pinna, and at the temporal recession). The occipital neurovascular bundle was then divided, and the same measurements were made. RESULTS: An intact occipital neurovascular bundle impeded the amount of advancement that could be accomplished with scalp-lifting. The anterior vector was primarily affected. CONCLUSION: In light of the finding that an intact occipital neurovascular hampers the amount of advancement with scalp-lifting, the surgeon must weigh the advantages and disadvantages of both approaches (prior division of occipital neurovascular bundles versus leaving the bundles intact) when deciding upon the appropriate approach for the given patient.

Adult↗
PubMedDate not supplied

Incidence of the concrete scalp deformity associated with deep scalp donor sites and management with the Unna cap.

The scalp has become a popular donor site for split-thickness skin grafts. This donor site does, however, have complications, including the concrete scalp deformity, which consists of hairs embedded in a thick, desiccated, exudative crust. This article presents our burn unit's experience with this complication. Fifty-six patients underwent scalp skin graft harvesting between 1984 and 1996. All grafts were quite thick and were used for resurfacing facial burns. Thirty-eight donor sites were treated with medicated gauze, and 18 were treated with the Unna cap, which is an Unna dressing applied over Aquaphor gauze (Beiersdorf, Norwalk, Conn). Eighteen of the 38 patients (32%) treated with medicated gauze developed the concrete scalp deformity. None of the patients treated with the Unna cap developed the deformity. Although useful, the deep scalp donor site has complications, including the concrete scalp deformity. However, with use of the Unna cap dressing, we have had no occurrences of this problem.

Adolescent↗
PubMed2003

[Treatment of overtime avulsion of scalp with split thickness scalp skin grafting: 7 cases of reports].

OBJECTIVE: To investigate a treatment method for overtime avulsion of scalp. METHODS: Form October 1992 to July 2001, we treated 7 cases of avulsed scalp, which had been wounded more than 12 hours and accompanied with shock and head wound, with split thickness scalp skin grafting. RESULTS: Except for partial necrosis of scalp in center of bare area of skull, more than 90% of grafting split thickness scalp skin survived in 4 cases and more than 80% in 3 cases, and presented satisfactory appearance during following up. The bare area had no periosteum above 4 cm in diameter needed to graft split thickness skin after skull was covered granulation tissue. CONCLUSION: The limits of time of scalp skin grafting will be prolonged as long as the processes are settled properly to maintain the skin of body.

Adult↗
PubMedDate not supplied

Reconstruction of massive defects of the scalp, cranium, and dura after resection of scalp neoplasms.

Massive defects of the scalp, cranium, and dura can be covered with local rotation, transposition scalp flaps. Five cases of massive defects of up to 300 square centimeters resulting from resection of scalp neoplasms were reconstructed by this technique. Excellent cosmetic and functional results were obtained in all cases. Although the emphasis in the recent literature has been on free flap coverage of these massive defects, our series demonstrates that these extensive scalp defects can be reconstructed using large local scalp flap transposition.

Adult↗
PubMed2003

Scalp hypothermia to prevent chemotherapy-induced alopecia is effective and safe: a pilot study of a new digitized scalp-cooling system used in 74 patients.

GOALS: The aim of this study was to examine the efficacy and safety of a new digitized, controlled, scalp-cooling system to prevent chemotherapy-induced alopecia. METHOD: Seventy-four female cancer patients who received 13 varying chemotherapy regimens were included in a nonrandomized pilot study. The Digni 2-3 with Dignicap system consists of a refrigerator unit and a control unit integrated into a mobile cabinet and connected to a tight-fitting cooling cap. This system maintains a constant scalp temperature of +5 degrees C for many hours. In this study, 60 patients were treated for ovarian cancer with either taxane or epirubicin combination chemotherapy. Eight patients with Hodgkin's lymphoma, three with breast cancer, two with endometrial cancer, and one with sarcoma were also included. Photo documentation and patient assessment of hair loss and discomfort were performed. RESULTS: In anthracycline-treated patients, total prevention of hair loss was observed, whereas hair loss in paclitaxel/docetaxel-treated patients was minimal to none. The combination of anthracycline and taxane resulted in more hair loss, but only three of six patients used a wig. Scalp cooling was generally very well tolerated; only two of 74 patients discontinued use of the cold cap due to discomfort. No scalp metastases occurred over a median follow-up period of 15 months. CONCLUSIONS: The digitized, controlled, scalp-cooling system represents an effective and safe device that should be clinically evaluated in a randomized trial and in studies using other chemotherapy regimens to determine optimal temperatures and durations of cooling for maximal efficacy.

Adult↗
PubMed2003

Successful treatment of recalcitrant dissecting cellulitis of the scalp with complete scalp excision and split-thickness skin graft.

BACKGROUND: Dissecting cellulitis of the scalp (DCS) is a therapeutically challenging, chronic, progressive, suppurative disease of the scalp that is of unknown etiology. In addition to causing considerable discomfort and cosmetic disfigurement, long-standing lesions may result in the development of squamous cell carcinoma. Several treatment modalities for DCS have been employed with variable results. OBJECTIVE: To report the successful treatment of an aggressive, refractory case of DCS with complete scalp excision and split-thickness skin graft. METHODS: A 25-year-old black male with DCS was treated with complete scalp excision and split-thickness graft from the anterior thighs. RESULTS: The patient has remained free of disease activity and is satisfied with the cosmetic result. CONCLUSION: Complete scalp excision with split-thickness skin graft may be curative in patients with DCS and should be considered in recalcitrant cases that fail to respond to medical therapy.

Adult↗
PubMed1985

Scalp stretching with a tissue expander for closure of scalp defects.

The authors show a way of reconstruction of scalp defects with excellent results using a tissue expander. This method creates "new" scalp tissue for coverage of defects with normal hair-bearing skin having a dense and even growth of hair. The hairs grow in the correct direction. The authors also show that almost all of the "new" hair-bearing scalp gained by the tissue expander is a result of stretching the scalp over the expander and its close surroundings and that only a very minute portion is gained by migration of the scalp from farther away.

Animals↗
PubMedDate not supplied

Contrast enhanced phototrichogram (CE-PTG): an improved non-invasive technique for measurement of scalp hair dynamics in androgenetic alopecia--validation study with histology after transverse sectioning of scalp biopsies.

Global changes of scalp hair represent the cumulative end result of discrete changes of individual hair follicle structure and/or function. Monitoring of such changes requires an accurate non-invasive method. The phototrichogram (PTG) appears to be an appropriate choice to do so. However, a known weakness of the method is the lack of detection of less pigmented or thinning hair. Balding scalp of male subjects with androgenetic alopecia (AGA) was analysed with our previously published PTG method and with contrast enhanced (CE-)PTG followed by biopsy and transverse section examination with the light microscope. As compared with PTG, the CE-PTG method significantly improved detection not only of thin but also of thick hair. Equal numbers of thick (diameter > 40 mm) hair were detected with CE-PTG and with histology. CE-PTG was also able to detect the severely miniaturised hair fiber (down to 8 mm diameter) and was comparable to scalp biopsy analysis. The latter could identify hair fibres, which did not reach the scalp surface, a measure that is considered as not clinically significant. All growth stages - anagen, catagen and telogen - as well as the empty follicle stage could clearly be observed with CE-PTG. Staging of the more severely affected hair follicles was not always possible neither with CE-PTG nor histology - even with serial sectioning. The finding of such technological advantages makes the CE-PTG a first choice method for detailed analysis of hair cycling in androgenetic alopecia - a scalp disorder characterised by extreme hair follicle miniaturisation, decreased hair pigmentation and hair thinning.

Adult↗