Microsurgical Replantation of a Two-Segment Total Scalp Avulsion

Hu, Weiguo; Henry, Anne Claire; Lucas, C.; Ta, Pierre; Philandrianos, C.; Kerfant, N.

doi:10.1097/scs.0000000000002637

Cited by 12 publications

(7 citation statements)

References 16 publications

(19 reference 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%

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%

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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“…Replantation is a method of reconnecting tissue or limb followed by the application of microsurgical technique. The first successful scalp replantation was conducted by Miller in 1976 [ 1 ]. Reportedly, only a few cases of partial or total scalp amputation can be found in the trauma unit [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Scalp amputation can lead to severe injury, permanent hair loss and massive blood loss. Partial defects can be managed by local flaps or skin grafts, while complete detachment may require free flap or replantation, with consideration of ischemia time and blood supplies for scalp survival [ 1 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Successful replantation of total scalp amputation due to dog bites in geriatric patient with prolonged tissue ischemia and comorbidities: a case report

Muzakkie

Hasbi

Tardha

2023

Journal of Surgical Case Reports

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Traumatic scalp amputation is a rare and life-threatening case causing massive blood loss and serious tissue damage. This report aims to record a successful scalp replantation on a 69-year-old woman with total scalp amputation due to dog bites. The challenges of this case were age, prolonged tissue ischemia and several comorbidities such as high glucose index (uncontrolled diabetes mellitus), hypertension and obesity. After 2 hours of admission, 9 hours of stabilization and 7 hours of revascularization, left superficial temporal artery and vein end-to-end anastomosis was successful, adding to 18 hours total of warm tissue ischemia time. The patient was discharged on Day 8 without signs of reperfusion injury or infection. Elderly patients with comorbidities and long-term tissue ischemia may be at risk for reperfusion injury and infection. However, sufficient vascular anastomosis, good tissue quality and optimal evaluation can achieve a good result.

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“…In the next couple of years, Buncke et al 4 and others [5][6][7] also reported successful scalp replantations with vascular anastomoses, and the microsurgery treatment has become the standard of care. [8][9][10][11] In this article, we will present 6 cases of scalp amputation and discuss our experience.…”

Section: Introductionmentioning

confidence: 99%

Experience in Microsurgical Treatment of Complete Scalp Avulsion

Lin¹,

Wei

Wang

et al. 2023

Ann Plast Surg

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Background: Avulsion of the scalp is a rare destructive event worldwide. Before the emergence of microsurgery, skin transplantation, flap transplantation, greater omentum transplantation, and other methods were once widely used. However, replantation offers the optimum reconstruction. Methods: Six cases of complete avulsion injury of a large scalp treated from May 2017 to May 2020 were retrospectively analyzed. Under the microsurgery technology, the wound was cleaned and explored, and the appropriate arteriovenous anastomosis was selected. Preoperative blood preparation and skin preparation were actively performed. Postoperative strict nursing and observation of the blood supply of replanted scalp were performed. Regular outpatient follow-up after discharge was performed. Results: Replantation was successful in 5 cases and failed in 1 case, and in 1 case the occipital scalp (approximately 10% of the scalp area) died and crusted 2 months after the operation. After 6 to 24 months of follow-up, all patients were satisfied with the reconstructed appearance. Conclusions: Superb microsurgical technique and more detailed anatomical knowledge are the key conditions for successful complete scalp avulsion replantation. Compared with other methods, successful replantation can achieve the best aesthetic and functional results.

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Microsurgical Replantation of a Two-Segment Total Scalp Avulsion

Cited by 12 publications

References 16 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

Successful replantation of total scalp amputation due to dog bites in geriatric patient with prolonged tissue ischemia and comorbidities: a case report

Experience in Microsurgical Treatment of Complete Scalp Avulsion

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