Repair of Wide Coup de Sabre without Cutaneous Excision by Means of Pericranial-Galeal Padding Flap

Abstract

A case of double linear scleroderma of the forehead (coup de sabre) is described. The histopathology of this rare lesion is now well known with a normal epidermis and a sclerotic dermis. The correction was done with an original two-stage procedure: the lesion with alopecia was first treated by excision-suture and a transfer of the involved subcutaneous tissue along the right inner canthus; 1 year later, by a hemicoronal incision, we transferred a galeal-pericranial flap beneath the wider forehead lesion. We think that the use of a filling flap to correct wide coup de sabre lesions without cutaneous excision can be a simple alternative to the classic treatment by complete excision and flap reconstruction. The subcutaneous fascial system of the scalp can provide a good donor site with minimal morbidity.

Survival of Grafts in Coup de Sabre

“…Such procedures include excision of the affected area with direct closure 2 or closure with skin graft, 2 myocutaneous flap, 3 or microvascular free flap. 3 Local rotation flap, 4 soft tissue expansion with excision of the affected area, 5-8 dermal filling flap, 9 local padding flap without skin resection, 10 autologous dermal fat graft, 11 and use of autologous and artificial bone grafts for bony defects 7,8 can also be attempted.…”

“…When activity has ceased, some operative interventions using skin flap and/or bone graft are safe and effective for the correction of deformity. [2][3][4][5][6][7][8][9][10][11] For the correction of alopecia due to chronic discoid lupus erythematosus (CDLE), leprosy, and traumatic alopecia, hair punch graft showed a high survival rate. [12][13][14][15][16][17][18][19][20][21] Long-term successful hair transplantation of linear scleroderma has been presented at medical meetings, although we could find no reports in the literature.…”

Secondary cicatricial and other permanent alopecias

“…Our experience with topical calcipotriol has been positive in terms of decreasing inflammation and preventing spread (personal observation). Flap and expander techniques as well as fat or polyethylene implantation are surgical treatment options (87–90).…”

Operative Korrektur einer Sklerodermie en coup de sabre durch En-bloc-Resektion

“…Bereits 1969 berichtete Moldenhauer über die operative Entfernung der Sklerosezone bei Sklerodermie en coup de sabre [10]; neben einfachen Exzisionstechniken wurden ferner der Einsatz spezieller Lappen-und Nahttechniken, die Verwendung von Gewebeexpandern, auch in Kombination mit autologen Knochentransplantaten und künstlichem Hydroxyapatit, sowie die Einbringung von Eigenhaartransplantaten in die haarlose Sklerosezone beschrieben [1,3,4,11,12,16]. Außerdem wurden Polyethylenimplantate zum Ausgleich deformierter Gewebebezirke eingesetzt [15].…”