Total Scalp Avulsion Research Articles

Considerations for Treatment of Total Scalp Avulsion.

Considerations for Treatment of Total Scalp Avulsion.

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.

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.

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.

Total scalp avulsion: Practical tips for successful replantation.

Total scalp avulsion: Practical tips for successful replantation.

Clinical decision model for the reconstruction of 175 cases of scalp avulsion/defect.

It has been reported widely on various methods of repairing scalp avulsion/defect, including anastomotic vessels for total scalp avulsion and dermal grafts (skin grafting, latissimus dorsi or anterior serratus flap, "visor flap" repair.). The long-term retrospective study, however, with large sample size remains rare; and there is no report on decision-making tree for repairing emergency scalp avulsion/defects under critical conditions. The decision-making model is provided for surgeons to design the scalp reconstruction based on the retrospective analysis of 175 cases of scalp avulsion/scalp defect. In this 10-year retrospective study, 175 cases of the repair of scalp avulsion and scalp defects in a single center were analyzed. The clinical decision model was generated based on representative cases. For patients with scalp avulsion/defects, a comprehensive examination and evaluation on systemic injury and complication should be conducted first for saving lives and reducing trauma effects. To make more reasonable clinical decisions, it is also required to determine the location, size, depth of scalp defect the injury area of cranial periosteum, injury of blood vessel or other adjacent organs, and whether the scalp can be reused. Meanwhile, it is necessary to evaluate whether the patient can tolerate long-term anastomotic vascular surgery according to the vital signs and physical status. The primary treatment goal is to decrease traumatic effects and save patient's life while repairing and reconstructing scalp avulsions and scalp defects. In addition, it is necessary to comprehensively consider the anatomical, functional and cosmetic characteristics of scalp, surgical equipment, team technical skillsets and patient's own pursuit to optimize a reasonable surgical solution.

Vascular consideration in repair of total scalp avulsion

Successful total scalp replantation was performed in our case. Based on the angiosome concept and anatomical study, the avulsed scalp survived with unilateral anastomosis of the superficial temporal artery and...

Application of Halo-vest head ring in replantation of total scalp avulsion

To investigate the clinical effect of Halo-vest head ring in the treatment of replantation of total scalp avulsion. We treated 11 cases of total scalp avulsion with the anastomosis of arteriovenous vessels and Halo-vest head ring from December 2006 to February 2015. One patient's replanted scalp got necrosis because of serious contusion which was healed without hair growth after free skin graft and dressing. All the scalp flaps in the other 10 patients survived. After 3-96 months follow-up, the wound completely healed, the scalp and hair grew well with satisfactory appearance. The use of Halo-vest head ring for replantation of total scalp avulsion can effectively improve the survival rate and survival area.

Treatment of total scalp avulsion by an advanced microsurgical method involving the subcutaneous tissue suspension by the tight suture of scalp tissue around anastomotic stoma.

Total scalp avulsion is a rare but challenging surgical trauma to manage. This study reports 8 cases of total scalp avulsion between 2001 and 2008. In all these cases, the patients were subjected to vascular replantation of the scalp. Microvascular technique after the debridement was used for scalp replantation in all these patients. Study outcome was that between 2001 and 2004, only 1 case had shown major scalp revival and scalp survival whereas in 3 other cases, the scalp survival failed. This may be attributed to the poor microscopic anastomosis. However, between 2005 and 2008, scalp survival was reported in all the cases, which was chiefly due the advanced microsurgical method adopted. In this advanced microsurgical technique, the subcutaneous tissue was suspended by the tight suture of scalp tissue around the anastomotic stoma, which resulted in scalp survival in all the cases. Microsurgical scalp replantation is an effective treatment for scalp avulsion. The key to the successful scalp replantation is high-quality vascular anastomosis involving subcutaneous tissue suspension via the tight suture of scalp tissue around the anastomotic stoma careful debridement.

My Beautiful Hair

Abstract Introduction This is a problem-base-learning (PBL) teaching case intended for first-year medical school human gross anatomy during the course of anatomical dissection and discussion sessio...

Emergency management of traumatic total scalp avulsion with microsurgical replantation

Total scalp avulsion is a rare but serious injury often resulting in defects of the hair-bearing skin, and it may even be life-threatening. Microsurgical hair-bearing scalp replantation is the first choice for the treatment of scalp avulsion. In this article, we describe the microsurgical replantation of two cases with total scalp avulsion. The avulsed scalp involved the hairy scalp, forehead, eyelids, ears, and part of the face. Initial management in the emergency department (ED) included correction of hemorrhagic shock with early blood transfusion, intravenous rehydration, and wound compression after rapid physical examination. A full trauma and preoperative workup prior to attempts at replantation needs to be performed to exclude any associated life-threatening injuries. Good form and function of the completely avulsed tissues and organs were achieved in both cases. Successful replantations can achieve the best esthetic and functional results when compared with other procedures. In addition to the microsurgical technique, preoperative evaluation and preparation in the ED are considered to be an important part of the successful salvage of the avulsed scalp.

Microsurgical reconstruction of major scalp defects following scalp avulsion

Introduction:Total scalp avulsion is a serious injury, commonly occurring in Indian females working with industrial and agricultural machines. Their long hairs often get caught in a rapidly revolving machines, resulting in total avulsion of scalp. Lack of education and awareness in Indian villages often result in these patients coming late to the hospitals when replantation is not possible and scalp reconstruction remains the only available option.Materials and Methods:We performed our study on 22 cases of scalp avulsion injury presented to us between June 2007 and April 2012 at Department of Burn, Plastic & Reconstructive Surgery, SMS Hospital, Jaipur. In all of them a free tissue transfer was performed as an elective procedure.Results:Twenty two patients underwent free tissue transfer and followed up for an average period of 6 months. All patients included in this study were females with mean age of 28 yrs. Five patients in our study reported with partial necrosis of the free flaps which were subsequently managed with split-thickness skin graft (STSG). Two patients reported total necrosis of the flap which was re-operated using latissimus dorsi along with serratus anterior muscle (LDSA) from the contralateral side.Conclusion:As scalp avulsion because of rapidly rotating machine leads to large size defect not amenable for local tissue reconstruction. We performed reconstruction using LDSA and omental free flaps with split thickness skin graft (STSG) for large scalp defect and achieved good and stable soft tissue cover with satisfactory cosmesis.

Total Scalp Replantation Salvaged by Changing the Recipient Vein

Successful replantation of the avulsed scalp has been reported by a number of authors, and there seems almost no doubt that each single superficial temporal artery and vein is enough to feed and drain the whole scalp if the amputee is not severely torn. As the venous problem is the most common cause of failure, efforts have been made to anastomose reliable veins for drainage. We report a case of total scalp avulsion that was, at first, fed and drained by a superficial temporal artery and an ipsilateral supraorbital vein. Congestion progressed slowly, and exploration revealed patent venous anastomosis without apparent thrombosis. Congestion was relieved when the recipient was changed to superficial temporal vein using a vein graft, leading to complete survival of the scalp. We propose the importance of the capacity of recipient vein, in addition to the anastomotic patency, for successful replantation of the whole scalp. We assume that the capacity of a small caliber recipient vein may be limited even in full dilatation, and the importance of the competent recipient vein should not be overlooked in a large amputee replantation or a large free flap surgery.

The microsurgical replantation of seven complete scalp avulsions: Is one artery sufficient?

Total scalp avulsion is a rare and devastating event. Microsurgical replantation is the sole method to achieve an ideal cosmetic outcome. In the literature, most studies have reviewed limited sample sizes. Most authors report better outcomes when a greater number of microvascular anastomoses are used. This strategy remains controversial, as some authors have suggested that one artery may be sufficient. From 2005 to 2008, seven patients who sustained scalp avulsion underwent microsurgical replantation. All of the vascular anastomoses were made with a branch of the superficial temporal artery. We did not use vein grafts. The ischaemia time was 4-16h. In six cases, a single artery and one to two veins were anastomosed; in another case, two arteries and three veins were anastomosed. Six of the seven scalp replantations were successful and achieved normal hair regrowth. In five of the six successful cases, we performed a single-artery anastomosis. Scalp avulsion is rare around the world but occurs relatively frequently in our country due to the lack of safe and secure working conditions in agriculture and industry. In cases where multiple arterial anastomoses are not possible, the present findings suggest that one branch of the superficial temporal artery may be sufficient to reperfuse the replanted scalp and achieve excellent aesthetic results.

Successful calvarial bone salvage using multiple outer table perforation technique on total scalp avulsion injury

For centuries, cranial outer table perforations were used to treat scalp avulsions that compromised the underlying periosteum. However, its use declined with the development of newer alternatives such as free-flap transpositions and scalp replantation. We report a case of extensive scalp avulsion with a large area of bone devoid of its periosteum. Outer calvarial plate perforations were drilled to promote granulation tissue growth. Skin grafts were used as a temporary coverage. The remaining scalp was then expanded, and the flaps obtained allowed a satisfactory coverage of the area of alopecia. The objective of this report is to bring this treatment method again into the set of possibilities to be considered when planning scalp reconstruction, as it is a feasible alternative and enables good results.

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

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.

Multiple cranial burr holes as an alternative treatment for total scalp avulsion

Total scalp avulsion is a devastating injury in clinical practice. It often occurs in female adults, being rare in children. The standard treatment for scalp avulsion is microsurgical replantation, when feasible. Coverage becomes a major problem when replantation fails or is contraindicated, resulting in significant morbidity and requiring multiple procedures. In this article, in addition to reviewing the literature, we report a historical method for obtaining skin coverage after failure of replantation. The authors report a case of a 10-year-old girl who had her scalp totally avulsed by an agricultural machine, including her right auricle. Microsurgery scalp replantation was attempted immediately after fluid resuscitation. The surgery failed probably due to the long time interval between trauma and surgery, which resulted in total ischemic time of 11 h and consequently made vascular microanastomosis impracticable. Multiple trephination of the calvarium was performed in order to expose the diploe. After 4 weeks, granulation tissue from the holes began to cover the defect, allowing the formation of a vascular bed suitable for skin grafting. Total scalp avulsion in children is seldom reported in the literature. Therefore, its management is both difficult and challenging. The exposure of the diploe with multiple burr holes is a safe and effective method for treating this injury. It may be considered, along with skin grafting, a good therapeutic alternative to be used when microsurgical replantation fails or is not feasible.

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

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.

Emergency management of total scalp avulsion

Scalp avulsion is a rare but severe injury and usually happens as an industrial accident. This report concerns a successful salvage in scalp avulsion resulting from hair entrapment in a...

Microsurgical Replantation for Child Total Scalp Avulsion

Total scalp avulsion is an intractable problem in clinical practice. It often occurs in female adults, but rarely in children. In this article, we described the replantation of 2 scalp segments in a 4-year-old girl. The right segment involved the hairy scalp merely, whereas the left one involved the hairy scalp, forehead, eyelid, ear, and part of the face. Warm ischemia time was about 28 hours, and operation time was 13 hours. Although an explorative operation was performed, the left segment survived partly. A relatively satisfactory aesthetic result was obtained by transplanting split skin from the abdomen and part of the survived right avulsed scalp. According to our experience, every effort should be undertaken to save the avulsed scalp, even in severely damaged and juvenile cases.