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Hair transplantation with flaps
Hair flaps are hair bearing areas of scalp which are moved with their blood supply intact. Many different flaps have been described. The two best known are the lateral scalp flap and the temporoparietoccipital flap. These flaps differ in several ways.
The lateral flap is a smaller flap from the side of the head. It is used mainly to reconstruct the front of the scalp. It is moved in a single stage and is best used in men who have stable hair loss.
A temporoparietoccipital flap is used for central as well as frontal hair loss. The flap is longer and is therefore performed in stages, called delays. In this way the blood supply of the flap is strengthened, so that when it is moved it is more likely to survive the transfer. Often more than one flap is used over a period of several months. In this way large areas of bald scalp can be replaced with hair bearing tissue.
A major disadvantage of these flaps is the sharp hair line at the front of the scalp. Several methods have been used to disguise this, including making the hairline irregular and concealing the line with micrografts.
Forehead or bow lifting should be completed before these flaps are used because the forehead lift incision is removed at the time of flap transfer.
Free flaps can also be used for scalp reconstruction In this situation the skin is detached, as in a graft, but after it is moved its blood supply is reestablished by linking it to blood vessels in the new location.