Scalping Research Articles

Considerations for Treatment of Total Scalp Avulsion.

Considerations for Treatment of Total Scalp Avulsion.

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

Scalp replantation is the best treatment for scalp avulsion due to its functional and esthetic benefits. Regular scalp replantation requires only unilateral or bilateral superficial temporal vascular anastomosis. However, shear force always damages vessels in severe scalp avulsions. Short, superficial temporal vessels (STVs) make tension-free anastomosis challenging. The objective of this article is to improve the regular scalp replantation technique. When the STVs are short, tension-free anastomosis, and cosmetic symmetry can be achieved without vein grafts or vascular replacement. This study retrospectively reviewed 18 patients with scalp avulsion, of which 10 underwent scalp-shifting replantation, and 8 underwent regular scalp replantation with direct anastomosis of the STVs. Postoperatively, the authors, assessed whether there was a significant difference in the percentage of scalp survival and in the facial symmetry of patients between the 2 methods. The percentages of scalp survival and facial symmetry were good after surgeries using both methods, and no significant differences were observed. The authors use scalp-shifting replantation to create tension-free anastomoses in cases where scalp avulsion injuries have left the superficial temporal arteries too short. This technique ensures facial symmetry, scalp reimplantation survival, and equally excellent results in function and esthetics.

Revolutionizing Scalp Avulsion Treatment: Unleashing the Therapeutic Potential of Pentoxifylline: A Case Report

Revolutionizing Scalp Avulsion Treatment: Unleashing the Therapeutic Potential of Pentoxifylline: A Case Report

Cultured Skin Autograft in Subtotal Pediatric Scalp Avulsion.

Pediatric scalp avulsions represent a reconstructive challenge because of the unique features of scalp tissue. When microsurgical reimplantation is not feasible, alternative approaches such as skin grafting, free flap transfer with latissimus flap, or tissue expansion are considered. Generally, there is no consensus regarding management of this trauma, and, oftentimes, multiple reconstructive techniques may be needed for definitive coverage. This case study describes the reconstruction of a pediatric subtotal scalp avulsion using a dermal regeneration template and novel autologous homologous skin construct. This case was complicated by the absence of original tissue for reimplantation, excessive size of the defect relative to body habitus, and family concerns for future hair-bearing function. The reconstruction successfully provided definitive coverage and significantly reduced the size of the donor site and associated compilations. However, the hair-bearing potential of the tissue has yet to be determined.

Dermal Substitutes and Skin Grafts in the Reconstruction of Post-Traumatic Total Scalp Avulsion: A Case Series.

Although scalp defects can vary in size and thickness, scalp avulsion represents a rare occurrence. This type of lesion may have different origins, but it is usually related to long hair being caught in agricultural machinery. The management of full-thickness scalp defects poses a challenge to the head and neck surgeon due to the possible involvement of neurovascular structures and scar retraction, which can affect the esthetic restoration of the area. Several algorithms for the choice of scalp reconstruction have been proposed in the literature and different techniques are available for extensive scalp defect reconstruction (local soft tissue flap, microvascular free flap, and skin graft combined with dermal substitutes), based upon the scalp defect type. Here we describe six cases of patients with total scalp avulsion, which required a combined reconstruction with a split-thickness skin graft (STSG) and Integra® matrix immediately after the trauma.

An Operation Restore Project: Procedure to Reconstruct the Eyebrows in a Victim of Scalp Avulsion from the Amazon

Every year, many women and children lose part of or their entire scalp violently due to the precarious conditions of the boats used for river navigation in the Amazon region. These accident victims suffer beyond their injuries as they become victims of extreme prejudice and are consequently

Experience in Microsurgical Treatment of Complete Scalp Avulsion.

Avulsion of the scalp is a rare destructive event worldwide. Before the emergence of microsurgery, skin transplantation, flap transplantation, greater omentum transplantation, and other methods were once widely used. However, replantation offers the optimum reconstruction. Six cases of complete avulsion injury of a large scalp treated from May 2017 to May 2020 were retrospectively analyzed. Under the microsurgery technology, the wound was cleaned and explored, and the appropriate arteriovenous anastomosis was selected. Preoperative blood preparation and skin preparation were actively performed. Postoperative strict nursing and observation of the blood supply of replanted scalp were performed. Regular outpatient follow-up after discharge was performed. Replantation was successful in 5 cases and failed in 1 case, and in 1 case the occipital scalp (approximately 10% of the scalp area) died and crusted 2 months after the operation. After 6 to 24 months of follow-up, all patients were satisfied with the reconstructed appearance. Superb microsurgical technique and more detailed anatomical knowledge are the key conditions for successful complete scalp avulsion replantation. Compared with other methods, successful replantation can achieve the best aesthetic and functional results.

The Utility of the Galea in Scalp Reconstruction

Total scalp avulsion is a time-sensitive, catastrophic injury requiring quick, complex decision-making. Traditionally, these injuries were treated with split-thickness skin grafts. With advancements in microsurgery, treatments evolved to scalp replantation, becoming the standard of care in scalp reconstruction. Although the integrity of the scalp’s blood vessels is pivotal for successful replantation, the authors believe that scalp replantation should be considered at all costs. In the presented case, a 54-year-old female presented to the emergency room following an incident with an auger that completely avulsed her scalp. She was taken back to the operating room, where scalp replantation was performed. Following replantation, scalp necrosis led to serial debridings in the operating room, and eventually, all of the scalp was debrided down to healthy tissue. Surprisingly, the galea survived despite this, which provided a healthy base for skin grafts. Before definitive coverage was placed, it was decided to utilize a bilaminar acellular dermal matrix along with negative pressure wound therapy to create a more robust bed of granulation tissue. After three weeks of this treatment plan, the patient returned to the operating room, where a healthy, viable bed of granulating tissue was revealed beneath the dermal matrix. Split-thickness skin grafts were taken from her thighs bilaterally and sewn together in a quilt-like fashion to cover the wound bed. The entirety of the graft healed without complication except for one small area that required full-thickness skin grafting in an outpatient setting. Even though the replantation ultimately failed, it allowed the galea to survive, which saved the patient from undergoing a free tissue transfer and allowed her scalp to be reconstructed with split-thickness skin grafts. Even in the setting of polytrauma, the authors hope that anyone treating a scalp avulsion would consider scalp replantation at all costs.

Staggered Setting of Latissimus Dorsi and Serratus Anterior Flaps for the Treatment of Scalp Avulsions: A Retrospective Study.

Although the incidence of scalp avulsion has decreased in recent years, it remains a major concern among plastic surgeons. We therefore aimed to introduce an improved free flap technique for repairing scalp avulsion with less tissue from the donor site. This method can achieve maximum primary closure of the donor site and improve its appearance and function as well as reduce the donor-site morbidity by ensuring that a smaller free flap can completely cover the scalp defect. Eight patients with scalp avulsion who had undergone staggered placement of the free flaps were evaluated. Data on the age, cause of scalp avulsion, scalp defect size, degree of avulsion, postoperative complications, and follow-up duration were analyzed. The postoperative evaluation criteria were donor-site sensation, latissimus dorsi muscle strength, upper extremity function, and quality of life. Patients' mean age was 38.7 years. The main cause of scalp avulsion was occupation-related accidents. The mean scalp defect size and postoperative follow-up duration were 26 cm × 20.4 cm and 41.5 months, respectively. One patient developed flap congestion postoperatively. The wounds at the recipient site healed well in all patients. There was no significant difference in the sensation between the surgical and nonsurgical sides. However, the latissimus dorsi muscle strength significantly differed between both sides. The mental component score, which was used to assess quality of life, did not significantly differ between the patients and healthy population, whereas the physical component score significantly differed between the two groups. None of the included patients had severe upper extremity functional limitation. Staggered placement of free flaps achieved maximum primary closure of the donor site and greater scalp avulsion defect coverage with less tissue excised from the donor site. Importantly, donor-site appearance improved and some donor-site functions were preserved postoperatively.

Eyebrow Reconstruction in Scalp Avulsion Victims from the Amazon

In 2014, when I was beginning my work in the hair transplantation field, I participated in a Congress of the Brazilian Association of Hair Restoration Surgery (ABCRC; Associação Brasileira de Cirurgia de Restauração Capilar), which took place in Maresias and where I had the opportunity to attend

SBCP Mission to Macapá, Brazil

In 2012, the Brazilian Society of Plastic Surgery (SBCP) planned two missions to Amapá state in the northern region of Brazil to assess and treat women who had suffered scalp avulsion from boating accidents. Under the leadership of Drs. Pedro Martins and Luciano Chaves (the coordinators of the

Complete Scalp Avulsion Treated With Tissue Replantation

Complete Scalp Avulsion Treated With Tissue Replantation

Replantation of Pediatric Scalp Avulsions.

Scalp avulsions are rare but can be quite morbid clinical manifestations. Pediatric patients are different from adults as they have not completed their physical, sexual, educational, or psychosocial development. Therefore, the devastation of a failed scalp replantation is much greater on these individuals, their whole future lives, and families. We present 2 consecutive pediatric cases retrospectively with the youngest successful replanted patient in Turkey and describe technical tips according to our experience.

Nonreplantable Total Scalp Avulsion Reconstruction with Acellular Biologic Matrix and Long-Term Outcome

Total scalp avulsion is a significant injury typically occurring as a result of industrial accidents involving high-speed rotary machines. Although ideal, scalp replantation is uncommon secondary to the nature of the injury and lack of viable microvas-cular anastomosis targets. Therefore, these defects are often reconstructed with microvascular free tissue transfer, with or without skin grafting. We present a unique case of a patient with total scalp avulsion achieving complete, stable skin coverage over partially intact periosteum using only spare parts of the amputated scalp as a temporary full-thickness graft and porcine urinary bladder matrix, thus, avoiding significant donor site morbidity or extensive surgery. At 4 years postoperative, the scalp coverage remains stable.

Traumatic Injuries From an Encounter With a North American Grizzly Bear

<h3>Introduction</h3> Estimates of grizzly bear, Ursus arctos horribilis, populations in North America include 25,000 in Canada, 30,000 in Alaska, and 1,918 in the lower-48 states.^1,2 Because of population growth due to wildlife conservation and increased outdoor recreation, bear encounters are more common in recent years, contributing to a greater incidence of human injuries.^3,4,5 Encounters are classified as "sudden," "provoked," or "predatory," with most human injuries being associated with "sudden" encounters in response to a perceived threat by the bear.^3,6,7 These encounters are likely to occur in the remote wilderness leading to a significant delay in treatment and transport to definitive care.⁸ We report a patient with injuries sustained from a "sudden" grizzly bear encounter who was treated and transported via helicopter emergency medical services (HEMS) to a trauma center. <h3>Case Report</h3> After a bear encounter in a remote wilderness area, a 41-year-old male patient sustained a scalp avulsion at the right occiput above the superior nuchal line and an approximately seven-inch laceration running contralaterally from the avulsion to the left occiput. Bleeding at both injury sites was self-limiting and successfully controlled with direct pressure. Substantial bruising and abrasions to the left anterior chest were noted, along with mild abrasions to the right hip and a puncture wound to the right posterior forearm. The patient's eyes also became irritated from capsaicin exposure when a bear spray canister deployed after being punctured during the encounter. The patient was alert and oriented without respiratory distress and displayed no signs of hemodynamic instability throughout the transport. Pain was managed with fentanyl and antibiotic prophylaxis was initiated with cefazolin. The patient was delivered to the trauma team at the receiving facility in a stable condition. <h3>Discussion</h3> Bear encounter injury patterns that predominate in the literature are puncture, avulsion, and crush injuries, notably to the head, face, and scalp.^3,6 These injuries stem from a combination of the bear's jaws, teeth, and claws. Infection risk is considerable due to aerobic and anaerobic species in the oral cavity as well as contamination with foreign material from the environment.^4,9 These injuries require thorough debridement and broad-spectrum antibiotic therapy should be initiated early. Capsaicin spray has been shown to be an effective bear deterrent and its use in this case, though incidental, likely contributed to termination of the encounter.^3,10 <h3>Conclusion</h3> This case underscores the serious and potentially life-threatening injuries that can result from encounters with grizzly bears and is consistent with previously reported encounters. Patients may present with complex soft-tissue and musculoskeletal injuries and risk of infection, requiring acute trauma resuscitation and early antibiotic treatment. Additional research on bear encounter injuries and their management will help improve the care of these patients by HEMS crews that are likely to care for these patients on "scene" flights or hospital transports to higher levels of trauma care.

75 Years of Excellence: The Story of Reconstructive Surgery

75 Years of Excellence: The Story of Reconstructive Surgery

Partial Scalp Avulsion From a Rotating Farm Machine in Pediatric Age.

Partial Scalp Avulsion From a Rotating Farm Machine in Pediatric Age.

Total scalp avulsion: Practical tips for successful replantation.

Total scalp avulsion: Practical tips for successful replantation.

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

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. 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. 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. 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.

Тактика лечения ребенка с черепно-мозговой травмой и укушенной скальпированной раной волосистой части головы (клиническое наблюдение)

Total separation of the scalp is a serious trauma in clinical practice. Common in adult women and rare in children. Among children, the most common cause of such injuries is animal bites, including dog bites. The article presents the experience of treating a two-year-old child who was admitted to the Regional Clinical Hospital No. 2 in Tyumen (Russia) with an extensive scalped wound of the scalp in combination with craniocerebral trauma, traumatic shock, multiple bitten wounds of the soft tissues of the head with a violation of the integrity of the upper lacrimal tubule. Immediately from the moment the child was transported by the ambulance team, anti-shock, antibacterial, decongestant, symptomatic therapy was started, primary surgical treatment of wounds was performed with restoration of the integrity of the upper lacrimal canal of the right eye. The child had no indications for neurosurgical intervention. The standard treatment for a detached scalp is, if possible, microsurgical replantation, but due to the impossibility of performing microsurgical replantation in this case (an infected wound, a skin flap was recognized as unviable by an interdisciplinary council), the defect was closed on a delayed basis with a fullthickness skin graft taking into account the blood supply and anatomical features bed. In this case, during the period of scalp plasty, there were no postoperative complications, the engraftment of autodermal grafts was satisfactory, and the healing of donor wounds was also satisfactory. The child was discharged for the outpatient follow-up stage after 3 months of inpatient treatment. In our opinion, the main reasons for achieving a good clinical result were an interdisciplinary approach to treatment, a combination of correctly performed primary surgical treatment of a wound, subsequent timely complex treatment in a specialized department, and a high regenerative potential of the child. In our opinion, the choice of the method of reconstructive intervention in patients with soft tissue and soft tissue bone defects of the scalp requires a differentiated approach, taking into account the etiology of the defect, its anatomical features and the possibility of compensating for aesthetic disorders. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: children, traumatic brain injury, scalp wound, scalp avulsion, treatment.