Reply: Reepithelialization from Stem Cells of Hair Follicles of Dermal Graft of the Scalp in Acute Treatment of Third-Degree Burns: First Clinical and Histologic Study

Hopital Trousseau, Centre Hospitalier RĂ©gional et Universitaire de Tours, Tours, Cedex,France.
Plastic and Reconstructive Surgery (Impact Factor: 2.99). 07/2012; 130(1):42e-50e. DOI: 10.1097/PRS.0b013e318254fa21
Source: PubMed


The scalp, an excellent donor site for thin skin grafts, presents a limited surface but is rich in keratinocyte stem cells. The purpose of this study was to double scalp harvesting in one procedure and to evaluate the capacity of the dermal layer to spontaneously reepithelialize from hair follicle stem cells.
Two layers of 0.2-mm split-thickness skin graft, a dermoepidermal graft and a dermal graft, were harvested from scalp during the same procedure. Fifteen burn patients were included in this study. Healing of the scalp donor site and percentage of graft taken were evaluated. The Vancouver Scar Scale was used at 3 months and 1 year. Histologic studies were performed at day 0 and 3 months on grafts, and on the scalp at day 28.
Nine patients were treated on the limbs with meshed dermal graft. Six were treated on the hands with unmeshed dermal graft. Graft take was good for both types of grafts. The mean time for scalp healing was 9.3 days. Histologic study confirmed that the second layer was a dermal graft with numerous annexes and that, at 3 months, the dermis had normal thickness but with rarer and smaller epidermal crests than dermal graft. The difference between the mean Vancouver Scar Scale score of dermal graft and dermoepidermal graft was not significant.
The authors' study shows the efficacy of dermal graft from the scalp and good scalp healing.
Therapeutic, II.

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    ABSTRACT: Scalp burns in the pediatric population appear relatively uncommon, with most reported cases occurring in adults secondary to electrical burns. We reviewed our experience with the management of these injuries in children. A retrospective review was conducted at our institution from March 2004 to July 2011. Scalp burns were defined as any burn crossing over the hairline into the scalp region. During the 7-year 4-month study, there were 107 scalp burns, representing 1.8% of the 6074 burns treated at our institution during that time. The cause was scald in 97, contact in 4, flame in 3, friction in 2, and chemical in 1. The majority (n = 93, 87%) appeared superficial to mid-dermal, with an average time to complete healing of 10.3 days. The remaining 14 cases (13%) were mid-dermal to full thickness, with an average time to complete healing of 50.8 days. Grafting was required in 12 cases (11%). The mean time to grafting was 4 weeks (range, 2 weeks to 2.5 months). The main complication of scalp burns was alopecia, which occurred in all grafted sites as well as in 4 patients treated conservatively. There were no other complications after grafting and no cases of graft loss. In our pediatric series, scalp burns were most commonly caused by scald injuries and were superficial to mid-dermal in depth. These generally healed rapidly but occasionally resulted in alopecia. The management of deep dermal and full-thickness scalp burns remains challenging in children, with the decision to graft often delayed.
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