Can I Have a Skin Graft After Scalp Cancer? (photo)

It is possible to have hair transplant surgery over a skin graft.  It has been done.  You would need an exam first (as always).  It would be helpful if the doctor you choose has had experience with similar cases.

Yes, this is possible. Consult a hair transplant surgeon and have them work in conjunction with your oncologists.

I have successfully transplanted hair after radiation.  However, the take of the grafts can be unpredictable due to damage of the skin.  In some patients after radiation I've had excelllent results, others are not as successful. 

There are a number of options you have, of course, I would have to see you to make an actual recommendation. The three options could include (1) scalp micropigmentation (see below), (2) scalp expanders and (3) hair transplants

It is possible to actually transplant hair to skin that has been grafted. In fact, we have been able to transplant hair on people who’ve had scars and burns with great success. However, when there is a history of radiation, there is always a concern about the blood vessels, vascular supply and whether it will be adequate to build the support for the hair follicles.
You mentioned that there is an indentation on your scalp with some fat atrophy or volume loss from the radiation. I would consider some different actions such as treating the indentation by something called Micro fat transfer. However, this is very dependent on the skin quality and whether or not there is a lot of scar tissue.
In our practice involving surgical hair transplant, we routinely use a material called extracellular matrix (ECM) that is made by ACell. This is a material that is derived from the bladder of pigs and it has a protein called a scaffold that has been used to help restore wounds, particularly open wounds, in the military or war injuries. I also have been using this material for the past 7 years for the treatment of hair loss and used the same material for several of my cosmetic and reconstructive surgeries. It works by regenerating tissues, so when used in hair transplants, it increases hair growth. When used in the body, it stimulates adult stem cells so that the wounds heal by duplication of the natural tissue that’s supposed to be there instead of healing by scarring
Before jumping right away to hair transplant, in my practice I would first do a physical examination and do a test session on the scalp. Here, I would transplant 100 or 200 hairs by microscopic surgical technique from the donor part of the scalp and inject extracellular matrix. After the surgery, we observe how those hairs grow. If they grow well, then the patient and I would have more confidence about going ahead with the procedure.

I have treated 5 similar cases in the past 6 years with tissue expansion . In  all cases we got the effect of full coverage although sometimes it took 3 procedures. Transplants , in my opinion, may not be as good a choice for scalp reconstruction, especially after radiation.