Emergency management of traumatic total scalp avulsion with microsurgical replantation

Abstract

Total scalp avulsion is a rare but serious injury often resulting in defects of the hair-bearing skin, and it may even be life-threatening. Microsurgical hair-bearing scalp replantation is the first choice for the treatment of scalp avulsion. In this article, we describe the microsurgical replantation of two cases with total scalp avulsion. The avulsed scalp involved the hairy scalp, forehead, eyelids, ears, and part of the face. Initial management in the emergency department (ED) included correction of hemorrhagic shock with early blood transfusion, intravenous rehydration, and wound compression after rapid physical examination. A full trauma and preoperative workup prior to attempts at replantation needs to be performed to exclude any associated life-threatening injuries. Good form and function of the completely avulsed tissues and organs were achieved in both cases. Successful replantations can achieve the best esthetic and functional results when compared with other procedures. In addition to the microsurgical technique, preoperative evaluation and preparation in the ED are considered to be an important part of the successful salvage of the avulsed scalp.

Acute otitis externa because of negative pressure wound therapy applied over the head and ear canal for scalping treatment

“…It is mandatory to offer trauma life support measurements, repair vessels injuries, and restore blood. 8,9 After adequate resuscitation, free tissue replantation is considered the first choice for reconstruction. [10][11][12] As performed in this case report, if replantation is not viable, a feasible option may be the use of a dermal regeneration matrix followed by delayed splitthickness skin grafting.…”

Scalp replantation in a cervical spine injury patient: Lessons learnt

“…Apart from having other life-threatening injuries, isolated total scalp avulsion patients may present with haemorrhagic shock. [ 2 ] Zhang et al . reported 9.4% of cases with scalp avulsion injuries have a cervical spine injury.…”

Ectopic implantation of an avulsed scalp with a tissue expander on a forearm for combined total scalp avulsion and spine injuries: A case report

“…Since the first successful scalp replantation was reported by Miller et al () other relevant articles, mostly case reports, have been published (Biemer, Stock, Wolfensberger, Ingianni, & Gotz, ; Buncke, Rose, Brownstein, Chater, ; Hentz, Palma, Elliott, & Wisnicki, ; Tantri, Cervino, & Tabbal, ; Yaffe & Shvoron, ). Scalp replantation is the first‐choice treatment for scalp avulsion in our department because it produces superior aesthetic results and psychological benefits relative to other treatment options (Cheng et al, ; Jiang et al, ; Liu, Dong, Wang, & Yang, ). However, the failure of scalp replantation not only results in multiple surgical stages but also causes great financial loss and emotional trauma to the patient (Mowlavi et al, ).…”

“…The main cause of scalp avulsion is the sudden pulling of hair by a high‐speed rotary machine. Traction forces and impact injuries often result in spinal cord and brain injuries that are contraindications for general anesthesia and the replantation of the scalp at the anatomical site (Jiang et al, ). In these situations, the scalp can be saved by temporary ectopic implantation.…”