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.

Conflict of interest statement

Conflicts of Interest Disclosure

There are no conflicts of interest for this article. All authors have registered online Self-reported Conflicts of Interest Disclosure Statement Forms through the website for the Japan Neurosurgical Society members.

Figures

Fig. 1.

Design of the skin incision. The incision in the temporo-parietal area is made posterior to the parietal branch of the superficial temporal artery. Each corner shows an angle of approximately 120°.

Fig. 2.

The beveled incision is made parallel to the long axis of the hair follicles. The dotted line demonstrates the incision.

Fig. 3.

Representative case (Case 2). a: Hair style in Case 2 at 1 month postoperatively. b: Hair loss is obvious over the scalp flap and around the scar. c: Close-up view of the rectangular area in panel b, showing hair growth over the scar (solid arrows). d: Hair style at 6 months postoperatively.

Fig. 4.

Hair style of a patient, who received conventional skin incisions, after > 6 years postoperatively.