J Korean Cleft Palate-Craniofac Assoc.  2011 Oct;12(2):116-120.

Treatment of Complete Scalp Avulsion with the Conditions of Unstable Vital Signs: A Case Report

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, College of Medicine, Kyung Hee University, Seoul, Korea. sykang@khmc.or.kr

Abstract

PURPOSE
Scalp avulsion is a life-threatening injury that may cause trauma to the forehead, eyebrows, and periauricular tissue. It is difficult to treat scalp avulsion as it may lead to severe bleeding. Therefore, emergency scalp replantation surgery is necessary, and we must consider the function, aesthetics, and psychology of the patients. A case of scalp avulsion leading to massive bleeding was encountered by these authors, which led to a failure to achieve the proper operation conditions in an adequate time period.
METHODS
A 49-year-old female was hospitalized due to having had her head caught in a rotatory machine, causing complete scalp avulsion which included the dorsum of the nose, both eyebrows, and ears. Emergent microsurgical replantation was performed, where a superficial temporal artery and a vein were anastomosed, but the patient's vital signs were too unstable for further operation due to excessive blood loss. Three days after the microanastomosis, venous congestion developed at the replanted scalp, and a medicinal leech was used. Leech therapy resolved the venous congestion. A demarcation then developed between the vitalized scalp tissue and the necrotized area. Debridement was performed 2 times on the necrotized scalp area. Finally, split-thickness skin graft with a dermal acellular matrix(Matriderm(R)) was performed on the defective areas, which included the left temporal area, the occipital area, and both eyebrows.
RESULTS
The forehead, vertex, right temporal area, and half of the occipital area were successfully replanted, and the hair at the replanted scalp was preserved. As stated above, two-thirds of the scalp survived; the patient could cover the skin graft area with her hair, and could wear a wig.
CONCLUSION
Complete scalp avulsion needs emergent replantation with microsurgical revascularization, but it often leads to serious vital conditions. We report a case with acceptable results, although the microanastomosed vessel was minimal due to the patient's unstable vital signs.

Keyword

Complete scalp avulsion; Microsurgical replantation

MeSH Terms

Debridement
Ear
Emergencies
Esthetics
Eyebrows
Female
Forehead
Glycosaminoglycans
Hair
Head
Hemorrhage
Humans
Hyperemia
Leeching
Middle Aged
Nose
Replantation
Scalp
Skin
Temporal Arteries
Transplants
Veins
Vital Signs
Glycosaminoglycans
Full Text Links
  • JKCPCA
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr