Nurse Practitioner / RN First Assist Stanford Children's Hospital Mountain View, California, United States
Description: Postoperative alopecia areata is a common dermatologic condition in which there is patchy, unpredictable hair loss and is a rare complication following prolonged immobilization of the head with general anesthesia. While pressure-induced ischemia is more commonly to blame, other causes may include cardiovascular/neurologic disease, malnutrition, and stress management. A retrospective chart review was performed of patients under the age of 18 at the time of microtia reconstruction at a single pediatric hospital between the years of 2016-2021 examining the incidence of postoperative alopecia areata. The perioperative and surgical teams, including surgeons, RN First Assist/Nurse Practitioner, anesthesiologists, surgical technologist, and circulator discuss patient and procedural concerns during the preoperative huddle and examine the scalp and operative site prior to skin preparation and draping. While pre and postoperative management may include evaluation of adequate nutrition and mental health, intraoperative use of pressure distributing positioning devices and routine scalp massages at identified intervals may improve tissue perfusion and decrease the risk for postoperative alopecia areata.