Microvascular Replantation of Totally Avulsed Scalps: Failures and Successes

Abstract

Total scalp avulsion is a rare but devastating injury currently without proven reconstructive techniques. While microsurgical anastomosis procedures have advanced and allowed for the replantation of digits and limbs, special anatomical considerations and risk of fatal blood loss add to the difficulty of replanting totally avulsed scalps. The authors present their replantation experience of 4 totally avulsed scalps between 2008 and 2017. Despite meticulous reconstructive techniques with proven success in limb and digit replantation, the first 3 cases failed due to various factors (i.e., thrombosis, venous congestion, reavulsion), and with experience, the fourth case was successful. Since total scalp avulsions are rare injuries, case reports are scarce, with only few publications commenting on failures which hold crucial information for surgeons to avoid pitfalls and optimize techniques. In this article, we highlight our experience with both successful and failed replantation of totally avulsed scalps, and offer recommendations and insight for optimization of this rare procedure.

Modified Scalp Replantation for Total Scalp Avulsion: Scalp-Shifting Technique

“…The current debate on scalp replantation focuses on the quantity and type of anastomotic vessels available, with some studies proposing that the arteries and veins should be anastomosed to the best possible extent 18 and others suggesting that anastomosis of 1 artery and multiple veins is sufficient for the prevention of flap congestion 19 . In contrast, evidence from other studies, including the current one, shows that a single artery and vein are sufficient for complete survival of the scalp due to good collateral circulation between the blood vessels 20–22 .…”

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

“…The presence of comorbidities must be addressed both before and after surgery, as they may be at risk of complications and mortality [ 8 ]. Antibiotics are also important for contaminated wounds, particularly for the bacteria most commonly found in dog mouths ( Pasteurella multocida ) [ 4 , 6 , 9 ].…”

Microsurgical replantation of a traumatic total scalp avulsion

“…However, only a handful of surgeons will have prior experience with this kind of injury. 5 Our aim of this article is to share our experience and thereby provide information that could help others if they are presented with a similar case.…”

“…Most of the larger departments of plastic and reconstructive surgery worldwide will have the necessary setup and equipment to perform the procedure. However, only a handful of surgeons will have prior experience with this kind of injury 5…”