Preservation of the Occipital Neurovascular Bundle in Extensive Scalp Lifting

Abstract

The authors present their experience with a new technique of preserving the axial blood supply of the bioccipitoparietal flap used in extensive scalp lifting (ESL). ESL is a significant contribution in the treatment of advanced male pattern baldness, allowing the excision of large amounts of bald scalp in a single procedure without the use of expanders or extenders. The occipital neurovascular bundle (ONB) is traditionally ligated as a delay procedure 4—6 weeks prior to the ESL. The authors have found that preserving the ONB significantly reduces the risk of ischemic complications in ESL procedures. In fact, no flap necroses were reported in 186 procedures using this technique. Furthermore, ESL with ONB preservation was performed with no ischemic complications in 78 patients (59%) who were traditionally not considered to be candidates for ESL because they had undergone prior hair transplant procedures. It is therefore shown that ONB preservation significantly streamlines ESL by eliminating the need for a delay procedure, decreasing or eliminating ischemic complications, and increasing the flexibility and scope of ESL by allowing patients with prior hair transplantation to be candidates for the procedure.