Complete avulsion of the scalp

Abstract

Summary 1.Treatment and its results in a series of twenty-four cases of complete avulsion of the scalp are reported. 2.The inadvisability of replacing the avulsed scalp, either as a whole or thinned down to a full-thickness graft, is emphasised. In no case yet reported has it been successful. 3.It is suggested that, until further work has been performed on the use of split split grafts cut from the avulsed scalp itself, the treatment of choice is immediate cover of areas with a pericranial base with split-thickness skin, best cut with the dermatome. Small areas of exposed bone, present in approximately 30 per cent. of cases, should be treated by excision of the superficial compact bone and immediate Thiersch grafting. 4.Late reconstructive procedures which have been employed in certain cases after initial healing are described. These include dermatome grafts to the forehead and the use of hair-bearing flaps to remove or alter the position of the bald area. 5.In cases inadequately treated, recurrent ulceration and severe scar contracture may occur as late complications. Recurrent ulceration may lead eventually to carcinomatous degeneration. Two cases are reported in illustration.