SKIN HARVESTING ON THE SCALP IN CHILDREN - UTOPIA OR REALITY

Since 1990 me have used systematically the scalp as donor site for spl it skin graft in children. The aim of this retrospective and prospecti ve study is to analyse the results, advantages, disadvantages: complic ations and problems of this method. Material and methods: The series i ncludes 43 children, age: 9 months to 15 years 6 months (mean age 5 ye ars 9 months) who presented bums or other lesions. The surface to be g rafted mas 0.5% to 35% of the body surface (mean surface: 6.6% TBS). T he follow-up was 25 to 1086 days (mean: 304 days). The donor site is p repared by marking of the hair-limit, sharing, desinfection and infilt ration with normal saline under the galea of the surface to be harvest ed. Skin harvesting is done with an electrical dermatome. The donor si te is covered with sponges soaked in adrenaline (1/500 000). Results: 1 child required harvesting twice in 2 weeks, another one 3 times in 3 months. AU the other children required only one procedure. 4 children needed a meshing of the graft. They required also harvesting from oth er donor sites. The surface to be grafted represented more than 15% TB S. 5 children with a surface to be grafted between 10 and 15% TBS coul d be covered in one session, without meshing, taking only the scalp. T he healing of the scalp nas complete after 7 to 14 days (mean: 9.5 day s). There was no mortality in our series. We were not confronted with any infection. No hypertrophic scars or retractions mere encountered. 3 children presented zones of alopecia, one had sequelae and needed tw o surgical procedures. The two other cases were minor cases and did no t require further treatment. A certain sparseness of hair mas noticed in a black girl, after the third harvesting. The blood losses were est imated as a total and have also to be attributed to the tangential exc ision of the burn area. Conclusion: Skin harvesting from the scalp in children can be recommended as first choice. Th; advantages, especiall y the rapid epithelialisation and the lack of visible scars, overcome the problems and the risks.