Total Scalp Avulsion with Microvascular Reanastomosis: A Case Report and Literature Review

Abstract

Total scalp avulsion is a rare but potentially devastating injury that when treated (following a few basic principles) can have very good reconstructive results. The present article reviews the current literature and describes the steps involved in the successful replantation of a complete avulsed scalp of a 33-year-old woman. To the authors’ knowledge, the present case regarding replantation of a complete avulsed scalp using only a single artery is the first to be described in the Canadian literature.

Successful replantation of the scalp with a good aesthetic outcome and return of sensation – a case report and literature update.

“…Finally, necrosis of the occipital part of the scalp is probably due to the crush, the highest avulsion impact and the gravitational dependence of the area [17].…”

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

“…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 .…”

“…8,9 After adequate resuscitation, free tissue replantation is considered the first choice for reconstruction. [10][11][12] 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 splitthickness skin grafting. 13 (Figure 2) Besides the definitive reconstruction, temporary coverage is often necessary to prepare the wound bed, with NPWT being an optimal choice.…”

Scalp replantation in a cervical spine injury patient: Lessons learnt

“…Although single artery and vein is enough to perfuse the whole scalp,[ 9 10 11 ] most of the authors have done as many vessels as possible. [ 8 12 13 14 ] Quilting sutures are important not only to prevent the minor shearing forces on anastomosis[ 9 ] but we also found it to be useful in obliterating a potential dead space and preventing hematoma collection which can lead to flap failure. [ 10 ] Intraoperative blood loss is significant if proper care is not taken in doing haemostasis.…”

“…[ 16 ] The occipital area necrosis is significant problem and multiple reasons have been discussed, most authors are of the opinion that it is the distal most part and least vascular or increased risk of venous congestion. [ 9 10 12 13 14 ] The other obvious reason is pressure necrosis due to immobilisation. Koul et al .…”