Serial scalp reductions: A biomechanical approach

BACKGROUND. Several technical aspects of scalp-reduction procedures still n eed to be clearly elucidated: in particular, (a) the quantitative effects p rovided by different amounts of subgaleal undermining, (b) the immediate ga ins provided by increasing amount of tension when advancing a scalp flap, a nd (c) the eventual benefits provided by galeotomies. OBJECTIVE. The aim of the present paper is to report on some biomechanical properties of scalp flaps as related to serial scalp reduction procedures f or correction of male pattern baldness. METHODS. Data were collected by stepwise loading of 20 scalp flaps, obtaine d by a reversed-Y scalp incision, after increasing amounts of undermining, as well as after performing three galeotomies. RESULTS. Increasing amounts of tension (while advancing a scalp flap) affec t the compliance of a scalp flap in a non-linear fashion; increasing amount s of undermining permit obtaining significant, but not proportional, gains; performing galeotomies is a useful adjunct to decrease the amount of closi ng tension when performing scalp-reduction procedures. CONCLUSION. When performing serial scalp reductions, to take into account t he biomechanics of scalp flaps may be of some utility in obtaining an optim al result.