Zigzag Skin Incision Effectively Camouflages the Scar and Alopecia for Moyamoya Disease: Technical Note

Abstract

Moyamoya disease is commonly diagnosed in children, and requires various vascular reconstruction to improve symptoms. Therefore, scar widening and hair loss after craniotomy, which sometimes occurs in this disease, are serious problems for patients. A variety of plastic surgical techniques in scalp have been reported to minimize the scar widening and hair loss. However, any neurosurgical reports describing this purpose have never been published for moyamoya disease. The objective of this study was to investigate whether these plastic surgical techniques could be applied to bypass surgery without any compromise of vascular reconstruction for moyamoya disease. We performed direct and indirect vascular reconstruction in six hemispheres of moyamoya disease patients not only in the middle cerebral artery territory but also in the anterior cerebral artery territory. The scalp incision was designed not parallel to the hair stream, and the bevelled incision was conducted not to jeopardize the hair follicles. The scar and hair loss were effectively camouflaged throughout the postoperative period in all cases. This study demonstrates that our design of scalp incision achieve effective vascular reconstruction and obscure the scar and hair loss.

Cosmetic Outcomes of Scalp in Standard Reverse Question Mark Incision and L.G. Kempe Incision in Large Craniotomies

“…However, some techniques in regular scalp incisions exacerbate hair loss. In Extracranial and Intracranial (EC-IC) bypass surgery, the vessels that feed the scalp are removed and anastomosed in the cerebral arteries, resulting in more pronounced hair loss compared with other neurosurgical procedures [2]. However, the findings of the researchers in this study did not reveal a clue of follicular damage which could lead to a decrease in follicular density and hair loss due to damage to the hair follicles.…”

“…However, some techniques in regular scalp incisions exacerbate hair loss. In Extracranial and Intracranial (EC-IC) bypass surgery, the vessels that feed the scalp are removed and anastomosed in the cerebral arteries, resulting in more pronounced hair loss compared to other neurosurgical procedures [2]. Today, surgical interventions should be performed with care and consideration of the cosmetic effect on patients because the craniofacial region is probably the most important area of the body in terms of aesthetics [3].…”

Time to Focus on the Scalp Incision Design for Chronic Subdural Hematoma: Technical Note and Experience

“…Aesthetic appearance of the scalp incision shape are concerned about the cosmetic results of surgeries, and an aesthetically displeasing scalp incision can result in a psychological burden, especially for those with thin hair or baldness [7]. The aesthetic satisfaction of patients has become an important index to evaluate surgical outcomes [8,9,12].…”

“…This degrades the surgical outcome, prolongs hospitalization, increases healthcare costs, and aggravates the physical and psychosocial distress of the patients. An ill-considered scalp incision can also cause aesthetic defects [6], and some patients may experience cosmetic self-consciousness that seriously affects their quality of daily life [7].…”

An Effective, Reproducible, and Cost-Effective Approach for Achieving Symmetry in Bicoronal Incisions in Pediatric Patients Undergoing Craniofacial Surgery

“…In an attempt to counteract the undesired issues that can sometimes be encountered with straight-line incisions, zigzag and curvilinear incisions have been adopted by several surgeons either for the full length of the incision, or in combination with a straight-line pattern. [1][2][3][4][5] Often, free-hand zigzag or curvilinear drawings require multiple attempts to ensure symmetry because of the need to create and replicate multiple bicoronal incision limbs that are of similar lengths and distances and angles from each other. This can be particularly challenging in asymmetric skulls where multiple anomalies exist.…”