View Full Version : Dr. Lindsey Stage 1 of a 3 stage major flap failure repair case, McLean VA

Dr. Lindsey
05-08-2012, 06:53 AM
This pleasant Aussie-UK fellow had an attempted temporal flap procedure done 25 years ago. Although he describes it getting infected, I’m pretty sure that the pedicle (blood vessel supplying the flap) got compressed or kinked, leading to rapid failure and necrosis (death) of the distal aspect of the flap. I say this for 3 reasons….1: If you look at what’s left, the portion that lived is essentially 3 times as long as it is wide—a standard ratio for random-non pedicled flaps used in facial reconstruction; 2: Its practically impossible to infect the forehead of a young healthy person after clean surgery; and 3: Having personally done about 80 vascularized pedicle nose reconstructions---this is the horror that we all worry about for the first few days—that the supplying blood vessel will get blocked and the flap will die.

Anyhow, he came over last week and our plan is 2 or 3 surgeries. First, we’ll do a strip hair transplant placed in a hairline that he finds acceptable, just a little above his flap. Second, after the hair has started to grow and is doing well, probably in 8-12 months, we’ll excise his flap, and advance his hairline down just a little, while at the same time taking advantage of his loose forehead skin to get a nice closure with hopefully an acceptable scar line…that looks better than the failed flap scar he currently has. We’ll take the hair out of the flap and place this behind his step 1 transplant, more on the right than left, as the blood supply to the right side of his head won’t be compromised by excision of the flap like the left side’s blood supply may be. And third, we’ll possibly do a 2nd strip case a year later to bolster the back.
All in all, quite an interesting case. As usual, he arrived the day before surgery so that we could make sure the plan was acceptable to both of us, then on Friday he arrived at 7:30 ready to go. The pictures show his donor area with some of his old flap scar visible on the left corner. He had an easy 3 layer closure and then received 2700 grafts. If you look at the distribution, you may wonder why there are more grafts placed on the left….and its due to our plan to put his failed flap hair in in part 2. The placers think we’ll get 700 out of the flap, I think it’s more likely to be 500, but I don’t want to put them on the left as the flap excision will cut through the supra-orbital and supra-trochlear vessels. While there is a lot of blood supply coming in from the sides and even the other side…I’m still cautious enough to want to place hair in the middle and right at step 2.
There weren’t any surprises in his case and he emailed me that he’s back in the UK and will get his sutures out on day 7 and then start scar care. I’m really excited about this case and I’m hopeful that his results are everything we both want.

Dr. Lindsey McLean VA

05-08-2012, 08:38 AM
I met this very nice gentleman and his lovely wife a couple of months ago in person and my heart went out to him as his flap surgery from over 30 years ago was just not in anyway shape or form appropriate and the poor guy had been so weighed down by it for decades. I am so so so looking forward to this result over the course of Dr Lindseys plan as it is going to be such a true life changer for the patient.

FULL respect to Dr Lindsey for taking such a very difficult case on. Many of us already know the man doesnt shy away from a challenge and in my opinion is one of the very few HT surgeons in the world capable of turning this guys life around!:cool::cool::cool:

Follicle Death Row
05-08-2012, 04:53 PM
This is going to be fascinating. I love seeing the outcomes of repair sessions. They can be absolutely life changing. I've seen some great restorations for radiotherapy patients and also an incredible burn patient restoration by Dr. Feriduni.

Must be very rewarding work. Looking forward to following this one.

Dr. Lindsey
05-14-2012, 11:04 AM
Yes, this does involve a fair amount of planning and patience.

And these repair cases are very gratifying. I see you commented on Dr. Feriduni and his work on radiation hair loss. I've currently done 2 of those cases and have posted both on this forum.

Given that my daughter had radiation to the head, but fortunately hasn't needed a hair case, I completely understand how devastating that can be to people...particularly kids.

Hats off to Dr. Feriduni!

Dr. Lindsey McLean VA

Follicle Death Row
05-14-2012, 05:09 PM
I've seen your restorations of radiotherapy induced hairloss and they're fantastic. With regards to Dr. Feriduni I was specifically referring to a burn victim repair case. Hopefully the mods can leave this link up.


It really is astounding.

Dr. Lindsey
05-15-2012, 06:49 AM
I agree That is a home run. Definitely one of the best cases I've seen.

Dr. Lindsey McLean VA

05-15-2012, 05:24 PM
Lots of respect to Dr. Lindsey and Dr. Feriduni for taking cases like this. I'm sure a lot of HT surgeons would turn down such cases due to risk and complexity.

Dr. Lindsey
05-29-2012, 07:00 AM
This is fun to plan, execute, and see results from. I'd do all of these that come to the office and that are repairable!

Dr. Lindsey McLean VA

Dr. Lindsey
06-08-2012, 05:28 AM
5 week pics just sent by the patient. As expected, most of the hair we put in has shed, scar is ok at 5 weeks.

Dr. Lindsey McLean VA

Dr. Lindsey
09-11-2012, 06:30 AM
4 month update, pics sent by patient.

So, a little fuzz is starting to grow and perhaps some of the hair we placed is turning on too. I'm getting psyched up for part 2, removing the failed flap--hopefully next summer.

Dr. Lindsey McLean VA

Dr. Lindsey
04-16-2013, 06:01 AM
This fellow is now a year out from 2600 grafts, of his relatively fine donor hair, and returns for step 2—to remove his failed flap procedure from the 1980’s. You may recall that because he had a large flap, which ultimately failed years ago, that his donor region is not terribly dense, and he has moderate quality hair. Step one was to do a hair transplant behind his flap. Step 2 will be to excise the flap and scar, and to place whatever hair we can get, at the back of his first transplant. Step 3, next year will be a second strip case to augment the frontal hairline, touch up any scar issues, and increase density.

He’s done quite well this year. These pictures were taken the day before starting step 2 which I’ll post separately in the next few days. He’s amenable to coming on and posting his story on occasion so I’d like his thoughts on this quite complex and challenging case.

Dr. Lindsey McLean VA

04-18-2013, 08:15 AM
A very realistic outcome. Nice Work!