Microsurgical Scalp Replantation: Lessons Learned and Technical Considerations

Abstract

Summary: Total scalp avulsion is defined as a severe soft-tissue injury which involves the hairy scalp and commonly occurs in women as a result of the entrapment of long hair in high-speed rotating industrial machinery. The first microvascular replantation of an avulsed scalp was described by Miller et al in 1976 when both superficial temporal arteries along with five veins were successfully reanastomosed. Our patient was managed with a vein graft measuring 8 cm in length for reanastomosis of the superficial temporal artery. Furthermore, after successful replantation, we used an expander for aesthetic refinement and achieved an excellent outcome. A scalp replantation should be performed in every possible case. Despite partial skin necrosis, hair growth in the remaining areas is possible. In cases of partial skin necrosis, it is possible to eliminate the hairless areas by implanting an expander and excising the hairless area. A pressure-related ulcer at the occiput is likely due to immobility of the head postoperatively and may be avoided by using a halo fixation device.

Microsurgical replantation of a traumatic total scalp avulsion

“…Miller et al used five veins and both superficial temporal arteries 8 10. More recent literature has described quite a few total scalp avulsions that were sufficiently reimplanted using only one artery and one or two veins for microvascular reconstruction 6 11. This is in accordance with our experience.…”

“…It is most frequently women who suffer this kind of trauma because it is often a result of the entrapment of long hair in high-speed rotating industrial machinery. 6 The first case of a scalp avulsion was described by Horovitz. In their case, the avulsed scalp was simply sutured back on without any microvascular anastomosis.…”

“…A total scalp avulsion is a rare injury. It is most frequently women who suffer this kind of trauma because it is often a result of the entrapment of long hair in high-speed rotating industrial machinery 6…”

“…Due to the low frequency of total scalp avulsions, no official consensus on treatment exists. However, Wechselberger et al have suggested an algorithm for treatment of total scalp avulsions 6…”

“…et al have suggested an algorithm for treatment of total scalp avulsions. 6 They suggest that replantation surgery should be used if possible. We agree that reimplantation surgery should always be applied if possible even in difficult cases such as an avulsed finger or in this case an avulsed scalp.…”