Arch Hand Microsurg.  2020 Dec;25(4):320-325. 10.12790/ahm.20.0058.

Successful Microsurgical Replantation of Scalp Amputation Using Medicinal and Chemical Leech Therapy: A Case Report

• Lee JH
• Kim DG
• Choi KY
• Chung HY
• Lee JS

• KMID: 2508948
• DOI: http://doi.org/10.12790/ahm.20.0058

Abstract

Scalp amputation is a very rare occurrence worldwide. In particular, replantation failure may occur from venous congestion, which represents a major complication of replantation. Accordingly, this study reports on a scalp amputation case with successful replantation treatment using medicinal and chemical leech therapy. On November 11, 2017, a 47-year-old female patient experienced a complete amputation injury starting from the top of the nose involving the total scalp by rolling machine that packs laundry. Severe venous congestion was controlled by medicinal leech therapy performed six times a day and chemical leech therapy (subcutaneous low-molecular-weight heparin injection) three times a day for 10 days. Approximately 85% of the scalp was replanted, and hair growth was confirmed. The basic concept of replantation surgery, “replace tissue with like tissue,” makes replacement impossible with tissues other than the hair-bearing scalp. Accordingly, the authors present a case of successful replantation with both medicinal and chemical leech therapy.

Keyword

Amputation; Traumatic; Salvage therapy; Replantation

Figure

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  Fig. 1. Preoperative findings. (A) Completely amputated defect on the scalp area. (B) Amputated stump.

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  Fig. 2. Severe venous congestion on the replanted scalp on postoperative day 2. (A) Anterior-posterior view, (B) left lateral view, and (C) crown view.

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  Fig. 3. Postoperative findings after microsurgical replantation after 2 weeks (A), 6 weeks (B), and 4 months (C). Follow-up observation was performed while continuing leech therapy. Venous congestion was improved in postoperative day 5, and wound healing was almost completed at 2 weeks postoperative. The views of anterior-posterior (D) and posterior-anterior (E) after 3 years. Hair growth is observed in approximately 85% of scalp flaps.

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  Fig. 4. Postoperative pack cell transfused, post-transfusion hemoglobin level, flap color, and conducted medicinal and chemical leech therapy protocol. The hemoglobin level maintained above 7 g/dL and congestive flap color resolved in length of time. The flap color is shown at the most congestive point in each period. The mean volume lessened from postoperative day 1 after vein graft. RBC, red blood cell; FFP, fresh frozen plasma; Hb, hemoglobin; H-vac, hemovac; LMWH, low-molecular-weight heparin.

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  Fig. 5. Contrast-enhanced three-dimensional computed tomographic angiography 4 months after the operation. The right (A), lateral (B), left (C) angles. On the lateral view, the right superficial temporal artery and vein are enhanced and delineated. However, the left superficial temporal artery and vein were not delineated.

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