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The experiences of scalp expansion in the treatment of scarred alopecia in 16 cases with 21 tissue expanders are presented. In 13 cases, the defects were over 90cm2 in area, the largest one extending over half of the total hair-bearing scalp. In all cases, apart from one, the expanding procedures were completed. In one case the procedures were partially completed because of extrusion of the expander. Follow-up of 13 cases for 6-24 months showed good hair growth and appearances and 2 cases had 1.2-1.5 cm of widened scar at the distal edge of the expanded scalp due to undue tension. The advantages, disadvantages and complications are discussed.

The free scapular fascial flap based on the circumflex scapular vessels with skin graft on top has been used to cover the soft-tissue defects in 6 cases--5 hands and 1 foot, over the past one year. The size of the fascial flap ranged from 10 x 6 to 13 x 7 cm. Five flaps were survival completely and one with loss of a small portion due to infection. Compared with the cutaneous flap, myocutaneous flap or muscular flap, the fascial flap is thinner, showing no bulkiness on the recipient site, and also no impairment was noted in the donor site. The shortcoming is darker colour of the skin graft overlying it. The authors consider that the free fascial flap is mainly indicated for the soft-tissue defects of the extremities and those sites where no augmentation is required.