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Abstract.The authors report their experience in successful reimplantation of avulsed scalp in two patients with one arterial and one venous anastomosis to the superficial temporal vessels. In both cases a double vein graft, harvested from the dorsum of the hand, was interposed between the pedicle of the scalp and the recipient temporal vessels to avoid tension after trimming of the damaged segments. Scalp replantation based on two or more vessels has previously been reported in the literature. In the present cases, the complete survival of the scalp on only a single vascular pedicle suggests that replantation should be considered also when the available vessels for the anastomosis are few. Moreover, even if these reconstructions are lengthy, a prolonged ischemic interval does not appear to be a significantly limiting factor for the success of the revascularization. The cosmetic and psychological success of these cases lend support to the idea that one should always attempt a microvascular replantation of avulsed scalps. Key words: Scalp -Reimplantation -MicrosurgerySince Miller and co-workers [8] reported successful replacement of avulsed scalp using microsurgical techniques, few other successful reports have been published [4][5][6][7][8][9][10][11][12][13]. The various authors have pointed out the technical problems which make the surgical procedure difficult and in many cases unsuccessful. The most common mechanism of scalp avulsion is that of wrenching, therefore the vessel edge is irregular and intimal damages are likely to occur. The superficial temporal vessels are the most suitable vascular pedicle although other vessels have been used for scalp revascularization [5,7,11]. The ischemic interval is prolonged by the search for and preparation of the vessels, particularly the recipient ones in the avulsed scalp [6,7]. In most cases, a single vascuCorrespondence to: M. Lorenzini, 1 ° Divisione Chirurgia Plastica, H. Borgo Trento, Pz. Stefani 1, 1-37126 Verona, Italy lar pedicle (one artery and one vein) is sufficient for the microsurgical repair [5,7,10]. Very often a vein graft for the artery and/or for the vein is necessary since the cut ends of the vessels are damaged and need revision and trimming [7,11,13]. Two cases of successful replacement of scalp avulsion are reported to add a further contribution to the treatment of this dramatic surgical event. Case reports Case 1A 25-year-old man suffered total avulsion of the scalp with all the frontal skin, both eyebrows and the right palpebral skin (Fig. la). In addition, there were fractures of the left arm as a result of an accident involving a pulley. He was admitted 2 h after the trauma with the scalp placed in a plastic bag chilled with iced saline solution. Upon examination, the area of avulsion extended from the occiput to the forehead including the eyebrows and both temples. The periosteum was intact. Another avulsed full thickness piece of right eyebrow and fight temple was included in the bag. This portion was not replaced since the temporal vessels ...

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After our experience with two patients who had persistent posttraumatic defects of the anterior skull base, we recommend using a deepithelialized free radial forearm flap for one-stage reconstruction. The flap provides a thin, water-tight barrier between the cranial cavity and the subcranial spaces for effective prevention of cerebrospinal fluid leakage and ascending infection. It is particularly useful when local flap options are not available.