Protocol of diagnosis and treatment for scalp avulsion injury

Abstract

Objective To search for a treatment approach for scalp avulsion injury based on the clinical experiences and review of literature. Methods Twenty-six consecutive scalp avulsion cases were involved in the study: 15 cases were complete scalp avulsion (5 including forehead skin) and 11 cases were partial scalp avulsion. Cranial bones exposure occurred in 16 cases, 11 of which had a size over 4×4 cm2. The treatment methods were various: 11 cases with microsurgical replantation, 9 cases with skin grafting, 4 cases with secondary skin grafting followed by multiple drilling of the calvarium, 1 case with local flap, and 1 case with free flap. According to the clinical cases and literature reviews, authors tried to search for an optimal protocol. Results Patients with microsurgical replantation achieved the best recovery including hair growth. In case of not qualified or fail to microsurgical replantation, skin graft could be considered as an alterative step, whereas the result of it was no hair growth and usually scar healing. In summary, 14 different clinical conditions followed with 10 surgical techniques were concluded in a route chart. Conclusions To achieve the optimal outcomes of scalp avulsion injury, proper techniques should be chosen according to the treatment protocols. Key words: Scalp avulsion injury; Microsurgical replantation; Skin graft