Bold to do — bald to be? Outcomes decades after harvesting the scalp in burned children

The scalp is the only hidden donor site for split thickness skin grafts. Nevertheless, it is underappreciated due to fear of iatrogenic scarring alopecia. Long-term data showing whether androgenetic hair loss can reveal previously hidden scarring alopecia is unavailable. We aimed to evaluate results and patient satisfaction up to 30 years after skin harvest from the scalp. Burn patients, hospitalized between 1977 and 1987 at the University Children’s Hospital Zurich with scalp skin harvest and currently over 30 years old, were studied. Medical records and patient satisfaction were analyzed, and a clinical scalp examination was performed. Thirty-two patients (18 males, 14 females) with a current age of 34.13 ± 3.42 years participated. Mean follow-up time was 27.09 ± 3.04 years. Fifty-four scalp harvests were performed with 1.69 ± 0.96 sequential harvests. Hair growth was considered normal in 97% patients. Androgenetic alopecia (AGA) type Norwood II–VI was seen in 11 patients. Scalp examination revealed 11 unknown likely harvest-related alopecias with a mean size of 0.7 cm2. Long-term morbidity of scalp skin harvest and the risk of clinically significant alopecia is very low while patient satisfaction is high. AGA is unlikely to reveal harvest damage previously hidden by regrown hair.