Incidence of the concrete scalp deformity associated with deep scalp donorsites and management with the Unna cap

The scalp has become a popular donor site for split-thickness skin grafts. This donor site does, however, have complications, including the concrete s calp deformity, which consists of hairs embedded in a thick, desiccated, ex udative crust. This article presents our burn unit's experience with this c omplication. Fifty-six patients underwent scalp skin graft harvesting betwe en 1984 and 1996. All grafts were quite thick and were used for resurfacing facial burns. Thirty-eight donor sites were treated with medicated gauze, and 18 were treated with the Unna cap, which is an Unna dressing applied ov er Aquaphor gauze (Beiersdorf, Norwalk, Conn). Eighteen of the 38 patients (32%) treated with medicated gauze developed the concrete scalp deformity. None of the patients treated with the Unna cap developed the deformity. Alt hough useful, the deep scalp donor site has complications, including the co ncrete scalp deformity. However, with use of the Unna cap dressing, we have had no occurrences of this problem.