Outcome of scalp donor sites in 450 consecutive pediatric burn patients

The scalp is a useful and reliable donor site in pediatric burn patients th at can be multiply harvested with minimal morbidity. Healing complications, however, may include alopecia and chronic folliculitis. To investigate sca lp donor-site morbidity, a consecutive series of 2478 pediatric burn patien ts treated over a 10-year period were reviewed. A total of 450 of these pat ients had scalp donor sites for wound closure. Percent of total body surfac e area burned was 46 +/- 23 percent (mean +/- standard deviation),and the m ean number of sequential scalp donor-site harvests was 2.2 +/- 2 (range, 1 to 10) with mean intervals between harvesting of 6 +/- 0.6 days. Ten patien ts (2.2 percent) had related complications. Eight patients developed scalp folliculitis, with Staphylococcus sp as the predominant organ ism (80 perce nt). Two patients were managed successfully with wound care alone; the othe r six patients required surgical debridement and split-thickness skin graft ing to achieve wound healing. These eight patients developed varying degree s of alopecia. Two patients developed alopecia without previous folliculiti s. Six patients required reconstructive surgery, which consisted of primary closure (3), staged excision (1), and tissue expansion (2). A number of va riables were examined to determine any differences in the group that had co mplications compared with the group of patients that did not. No difference s in age, sex, race, burn type, burn size, septic episodes, time to wound c losure, or number of times the scalp was harvested were detected. Healed se cond-degree burns to the scalp that were subsequently taken as donor sites seemed to be a risk factor (p < 0.05) for folliculitis and alopecia. Our study confirms that scalp donor sites are reliable with low morbidity. Complications include alopecia and chronic folliculitis that can be avoided by meticulous technique and avoidance of previously burned areas.