Scalp as a donor site in children: Is it really the best option?. Issue 5 (August 2018)

• Record Type: Journal Article
• Authors: van Niekerk, G.; Adams, S.; Rode, H.
• Is Part Of: Burns. Volume 44:Issue 5(2018)
• Page Start: 1259
• Page End: 1268
• Publication Date: 2018-08
• Subjects: Burns -- Pediatric -- Scalp donor site -- Complications; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2018.02.021
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Worldwide the scalp is advocated as preferred donor site for SSG's, especially for facial resurfacing. Studies reported was done on Caucasians, which is not representative of RCWMCH's burn victim population. The scalp as donor site in patients with hair types IV–VI, resulted in significant complications. These complications encountered were at a significantly higher rate than previously reported in the literature. This is likely due to the morphologic differences in specific hair types (hair & follicle), as well as different growth patterns. Abstract: Background: Since 2003 we have used the scalp as a donor site for split skin grafts (SSGs) in major burns when there was a shortage of conventional donor areas. However, we seen a high incidence of complications, contrary to international experience. Objective: The aim of this study was to analyze the results and complications related to the scalp as a donor site and to determine whether there is an association between our specific patient population and the complications encountered. Methods: A retrospective review of our scalp donor site outcomes over a 12-year period was conducted. The cohort included 25 patients, 15 of black African descent, nine of mixed race and one Caucasian. The various hair types were identified based on ethnicity and classified into eight types. Most of our patients had hair types VI–VIII. None of these patients had scalp burns and all received standard burn treatment. The SSGs were taken with an electric dermatome with a standard micrometric setting of 0.2 mm. Complications were categorized into short- or long-term, with a mean follow-up time of 1.59 years. Results: The mean age of the 25 children was 5.7 years. Nineteen sustained flame burns and 6 sustained hot water burns, with a mean total body surface area of 44.9%. A total of 43 scalp procurements were performed in the 25 patients studied. The group of 15 black African patients (hair types VI–VIII) had a total of 22 procurements, the nine patients of mixed race (hair types III–V) had 18 procurements and the single Caucasian patient (hair types II–III) had two procurements. The median healing time was 15 days, 11.8 days and 8.5 days, respectively, per group. Significant complications were encountered, including folliculitis 44%, non-healing wounds 52%, alopecia 16% and visible, hypopigmented scars 3%. One patient had a hypertrophic scar and no hair transfers to the recipient areas were observed. The various hair types correlated with the complications encountered. Five children, with an average burn size of 65.2% (range: 40–85%) died of sepsis. Due to the small sample size, the only statistically significant findings were related to the total body surface area of the burn and the number of times skin was harvested from the scalp, with a p-value of 0.005. The p-values for the healing times related to the first, second and third croppings, were p = 0.022, p = 0.00032 and p < 0.001 respectively. Conclusion: Our study suggests that in pediatric patients of black African descent (hair types VI–VIII) the scalp is not an ideal donor area, due to the unacceptably high incidence of complications. Hence, every precaution should be taken when it becomes necessary to harvest donor skin from the scalp.