Long-Term Multimodal Reconstruction of Extensive Post-Burn Scalp Alopecia Using Tissue Expansion and Follicular Unit Extraction: A 10-Year Follow-Up Case Report

ABSTRACT Introduction: Extensive scalp wounds following trauma, particularly burns, present a significant reconstructive challenge. Multidisciplinary long-term care is required to restore function and aesthetics while minimizing complications. Methods: We report a 35-year-old male with second- and third-degree burns covering 70% of his body, including face, trunk, and upper limbs. Scalp reconstruction involved tissue expansion, rotational flaps, partial-thickness skin grafts, and multiple follicular unit excision (FUE) hair transplant sessions. Results: Scalp expansion and flap rotation reduced scarred areas but left residual alopecia, which was successfully treated with four FUE sessions (totaling 2,946 scalp and 1,468 beard follicular units), achieving near-complete restoration. Graft survival was satisfactory, and the patient regained functional and aesthetic outcomes, with reintegration into social activities. Discussion: Multimodal reconstruction, including biologic dressings, scalp expansion, and staged hair transplantation, is effective for post-burn scalp alopecia. Challenges include reduced vascularization, fibrosis, tissue rigidity, prolonged hospitalization, increased risk of infection, and other clinical complications, which require careful planning and multiple procedures to optimize graft survival. Conclusion: Complex scalp reconstruction in burn patients is feasible with a combination of advanced wound care, tissue expansion, skin graft, flap rotation, and FUE transplantation, leading to durable aesthetic and functional outcomes.