Total scalp avulsion with microvascular reanastomosis: A case report and literature review

Plant, Mathew A; Fialkov, Jeffrey A.

doi:10.4172/plastic-surgery.1000657

Cited by 12 publications

(20 citation statements)

References 19 publications

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“…It is mandatory to offer trauma life support measurements, repair vessels injuries, and restore blood . After adequate resuscitation, free tissue replantation is considered the first choice for reconstruction . As performed in this case report, if replantation is not viable, a feasible option may be the use of a dermal regeneration matrix followed by delayed split‐thickness skin grafting .…”

Section: Discussionmentioning

confidence: 92%

Acute otitis externa because of negative pressure wound therapy applied over the head and ear canal for scalping treatment

Castro

Coltro

Jorge

et al. 2018

International Wound Journal

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Scalping is considered a complex wound with difficult treatment, requiring early surgical intervention, reconstructive plastic surgery, and a multidisciplinary team. The reconstruction of the scalp frequently requires a combination of therapies, including temporary coverage, such as negative pressure wound therapy (NPWT). Complications of NPWT, such as bleeding, infection, and pain, have been described. However, there is no report of acute otitis externa (AOE) because of NPWT. In this article, we present an unprecedented clinical case – a female patient who developed AOE after scalping treatment with NPWT applied over the head and ear canal. We consider that it may be a result of the direct physical action of subatmospheric pressure, the presence of dressing covering the external meatus, and alteration of the bacterial population.

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Section: Discussionmentioning

confidence: 92%

Acute otitis externa because of negative pressure wound therapy applied over the head and ear canal for scalping treatment

Castro

Coltro

Jorge

et al. 2018

International Wound Journal

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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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“…3,11,12 Venous grafting has also been criticised since it is associated with a longer operative time. 13 Nguyen et al and then Sabapathy et al never used vein grafts over 6 successful total scalp replantations. 5,7 In our opinion, multifragmented scalp avulsion is a different situation.…”

Section: Discussionmentioning

confidence: 98%

Microsurgical Replantation of a Two-Segment Total Scalp Avulsion

Henry

Lucas

et al. 2016

Journal of Craniofacial Surgery

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Total scalp avulsion is a rare and severe injury that may be life threatening and can result in devastating disfigurement and psychological trauma. Microsurgical hair-bearing scalp replantation is considered the procedure of choice and should be performed by a skilled surgical team. Replantation of a multifragmented scalp is even rarer and shows random results. Only 2 patients have been reported, resulting in partial or total necrosis of implanted fragments. The authors describe the successful replantation of a totally avulsed 2-segment scalp in a 63-year-old woman whose hair was entrapped in the propeller shaft of a ship. The avulsed scalp involved both eyebrows, the frontal region, the upper part of both ears, and most of the occipital portion. After initial management including correction of hemorrhagic shock, the patient underwent emergency scalp replantation by microsurgical anastomosis of 3 arteries and 4 veins and the use of 2 vein grafts.According to authors' experience, multifragmented scalp avulsion imposes emergency relocation using as many microsurgical sutures as possible and implementation of vein grafts to ensure optimal revascularization of the avulsed scalp.

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Total scalp avulsion with microvascular reanastomosis: A case report and literature review

Cited by 12 publications

References 19 publications

Acute otitis externa because of negative pressure wound therapy applied over the head and ear canal for scalping treatment

Acute otitis externa because of negative pressure wound therapy applied over the head and ear canal for scalping treatment

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

Microsurgical Replantation of a Two-Segment Total Scalp Avulsion

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