Successful Replantation of a Totally Avulsed Scalp following Prolonged Ischemia

Vr, Hentz; Cr, Palma; Elliott, Eugenne; Wisnicki, Jeffrey L.

doi:10.1097/00000637-198108000-00011

Cited by 12 publications

(5 citation statements)

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“…Of 704 initial results, 61 studies were selected for data analysis. 1 2 4 5 6 7 8 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 ( Fig. 1 ) Nine studies included sample sizes of five-or-more patients.…”

Section: Resultsmentioning

confidence: 99%

“…65 It is important to note that a single successful scalp replant with 24 hours of ischemia time was reported in our sample. 26 Replantation even after prolonged ischemia likely should be attempted as even partial success can restore hair-bearing skin. 2 3 In such cases, indocyanine green angiography may allow intraoperative prediction of replant survival.…”

Section: Discussionmentioning

confidence: 99%

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Identifying Factors Affecting Outcomes in Scalp Replantation: A Systematic Review of the Literature

Kotamarti

Heiman

Camargo

et al. 2021

J Reconstr Microsurg

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Introduction Replantation is the ideal treatment in traumatic scalp defects to provide immediate coverage with restoration of hair-bearing skin. However, data are limited to case reports and small case series. Comprehensive analysis of techniques and outcomes is not available. Our aim was to systematically analyze the available literature to better understand management and postoperative outcomes of patients undergoing scalp replantation. Methods A systematic review of the PubMed, Cochrane, and EBSCO databases was performed in October 2019. Search terms included “replantation,” “replant,” “revascularized,” “revascularization,” “avulsion,” and “scalp.” Only papers reporting microvascular replantation of completely avulsed scalps, including case reports, were included. Review articles, non-English language articles, articles discussing nonreplant coverage, incomplete scalp avulsions, and articles discussing delayed scalp replantation were excluded. Data extracted included demographics, percent of scalp affected, mechanism, operative technique, and postoperative outcomes. Statistical analysis was performed using Mann–Whitney U tests, Kruskal–Wallis, and chi-squared tests. Results From a total of 704 initial results, 61 studies were included for analysis comprising 149 scalps. Complete survival was achieved in 54.7%, partial survival in 38.9%, and failure in 6.7%. Total ischemia time greater than 12 hours was associated with complete replant failure. Arterial anastomoses appeared to protect against complete loss. The number of venous repairs, proportion of venous-to-arterial repairs, use of vein grafts, thromboprophylaxis, or intraoperative complications did not affect outcomes. Patients required significant volumes of blood products, which was associated with partial success. Salvage rate after unplanned return to the operating room was 60.0%. Normal hair growth was achieved in all surviving native scalp tissue. Conclusion Scalp replantations, while technically challenging, are the ideal treatment for scalp avulsions. Fortunately, these have high rates of success. And as a focal point of a patient's appearance, this is invaluable in restoration of a sense of normalcy.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Identifying Factors Affecting Outcomes in Scalp Replantation: A Systematic Review of the Literature

Kotamarti

Heiman

Camargo

et al. 2021

J Reconstr Microsurg

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“…Total scalp avulsion is a rare but serious injury that often involves defects of the hair‐bearing skin. 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, ).…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

et al. 2016

Microsurgery

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Total scalp avulsion with severe cervical spine injury is a contraindication for emergency replantation of the scalp to its anatomical site. We describe a case involving the ectopic implantation of an avulsed scalp on the forearm. A 41-year-old woman presented with severe total scalp avulsion and tears in the intervertebral discs at the C4/5 and C5/6 levels. The avulsed scalp was ectopically implanted on the left forearm with a tissue expander to provide support. Two-stage replantation of the scalp at its anatomical site was performed 19 and 40 days later. Replantation was successful, and the avulsed tissue exhibited excellent viability. In conclusion, this case shows that the ectopic implantation of the avulsed scalp on the forearm may be an option for total scalp avulsion with cervical spine injury.

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“…After the first successful scalp replantation reported by Miller et al in 1976, [1] some articles, mostly case reports, were published. [2][3][4][5][6] Since that time, microsurgical replantation has been considered the first choice in the treatment of scalp avulsion. Our department has accumulated experience in successful replantation of a completely avulsed scalp.…”

Section: Introductionmentioning

confidence: 99%

Emergency management of traumatic total scalp avulsion with microsurgical replantation

Jiang¹,

Li²,

Cao³

2014

Ulus Travma Acil Cerrahi Derg

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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.

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Successful Replantation of a Totally Avulsed Scalp following Prolonged Ischemia

Cited by 12 publications

References 0 publications

Identifying Factors Affecting Outcomes in Scalp Replantation: A Systematic Review of the Literature

Identifying Factors Affecting Outcomes in Scalp Replantation: A Systematic Review of the Literature

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

Emergency management of traumatic total scalp avulsion with microsurgical replantation

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