Microsurgical Replantation for Child Total Scalp Avulsion

Abstract

Total scalp avulsion is an intractable problem in clinical practice. It often occurs in female adults, but rarely in children. In this article, we described the replantation of 2 scalp segments in a 4-year-old girl. The right segment involved the hairy scalp merely, whereas the left one involved the hairy scalp, forehead, eyelid, ear, and part of the face. Warm ischemia time was about 28 hours, and operation time was 13 hours. Although an explorative operation was performed, the left segment survived partly. A relatively satisfactory aesthetic result was obtained by transplanting split skin from the abdomen and part of the survived right avulsed scalp. According to our experience, every effort should be undertaken to save the avulsed scalp, even in severely damaged and juvenile cases.

Total Scalp Replantation

“…Most of the scalp amputations result from avulsion traumas that may lead to serious injury in the intimal wall of the habitant vessels, thus favoring thrombogenesis. 12 For this reason, the authors recommend a careful inspection of the vascular stumps and not to hesitate to resect the damaged vascular segment and use of interpositional vein grafts in return. In addition, the potential donor sites for vein graft harvesting should be prepared in advance.…”

An impressive case of complete traumatic maxillofacial degloving

“…The aetiology of facial avulsion injuries is diverse, the most common are falls from trees, automobile accidents and accidents involving machines 6,8,10 . Most cases of avulsion caused by direct trauma are limited to small areas, such as the eyebrow, lip or ear.…”

“…Avulsion injuries involving the complete degloving of the affected segment require immediate treatment and generally involve the use of hyperbaric oxygenation and microsurgical techniques to reduce tissue necrosis and the various aesthetic and psychological complications stemming from this necrosis 4,7,9 . A patient with total avulsion of the scalp was treated by microsurgical reimplantation based on the bilateral temporal vessels 6 . The case presented here differs from cases in the literature, both in the extent of the affected area and the possibility of successful repair without the use of hyperbaric oxygenation or microsurgical techniques.…”

“…This type of injury involves the separation of the skin and subcutaneous tissue from the bones, compromising the adjacent fascia, muscles, blood vessels and nerves 8 . Such injuries are more common in the hands, but may occur in other parts of the body, such as the craniofacial region 4,6 .…”

Emergency management of traumatic total scalp avulsion with microsurgical replantation

“…Successful scalp replantation has been carried out in our department since 1991, [7,9,10] and many cases, including pediatric total scalp avulsion, have been published by our department with improvements in the microsurgical technique. [7,11] In addition to the microsurgical technique, preoperative evaluation and preparation in the ED are considered to be an important part of successful salvage of the avulsed scalp.…”