Reconstruction of Scalp Scar and Alopecia with Multiple Tissue Expanders and Zigzag (Puzzle) as a New Method

Background and Objective: Repairing scalp scar and alopecia is a concern of surgeons. Treating it with tissue expander has indicated promising results in recent decades. This study provides a new method of using two tissue expanders simultaneously for tissue over expansion and repairing flaps’ edge with puzzle method. Materials and Methods: This study was conducted on fifteen 5 to 34- year- old patients with scalp scar greater than 100 cm2. Two tissue expanders were used for each patient. Appropriate expansion was achieved with twice injections of 5-8 cc/cm2 (6.5 average) normal saline weekly during 80 days. In the second surgery, both tissue expanders were extracted and the scar was removed. Then, advancement and rotational flaps were prepared and the repair was carried out with puzzle method. The patients were followed up for 3-6 months. Results: No case of wound infection and seroma was observed. Over expansion occurred with an average of 3.3 times larger than scar size. No evidence of expander extrude, flap necrosis or recurrent scarring with more than 3 mm width were seen. New scar became totally hidden with hair. No one needed hair follicle grafting. Patient satisfaction was good to excellent. Conclusion: Using multiple tissue expanders to accelerate overexpansion and repairing with puzzle (zigzag) method reduces patient referral, waiting time, new scaring and complications and leads to promising cosmetic results.