Skin Harvesting on the Scalp in Children: Utopia or Reality

Abstract Since 1990 we have used systematically the scalp as donor site for split skin graft in children. The aim of this retrospective and prospective study is to analyse the results, advantages, disadvantages, complications and problems of this method. MATERIAL AND METHODS: The series includes 43 children, age: 9 months to 15 years 6 months (mean age 5 years 9 months) who presented burns or other lesions. The surface to be grafted was 0.5% to 35% of the body surface (mean surface: 6.6% TBS). The follow-up was 25 to 1086 days (mean: 304 days). The donor site is prepared by marking of the hair limit, shaving, disinfections and infiltration with normal saline under the galea of the surface to be harvested. Skin harvesting is done with an electrical dermatome. The donor site 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. All the other children required only one procedure. 4 children needed a meshing of the graft. They required also harvesting from other donor sites. The surface to be grafted represented more than 15% TBS. 5 children with a surface to be grafted between 10 and 15% TBS could be covered in one session, without meshing, taking only the scalp. The healing of the scalp was complete after 7 to 14 days (mean: 9.5 days). There was no mortality in our series. We were not confronted with any infection. No hypertrophic scars or retractions were encountered. 3 children presented zones of alopecia, one had sequelae and needed two surgical procedures. The two other cases were minor cases and did not require further treatment. A certain sparseness of hair was noticed in a black girl, after the third harvesting. The blood losses were estimated as a total and have also to be attributed to the tangential excision of the burn area. CONCLUSION: Skin harvesting from the scalp in children can be recommended as first choice. The advantages, especially the rapid epithelialisation and the lack of visible scars, overcome the problems and the risks.