CASE HISTORY – August 2011

Total scalp avulsion: an attempt of replantation


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Most avulsion scalp traumas occur among women mainly in situations where they work with moving mechanisms and leave their hair uncovered. At the same time, as scalp traumas are quite rare, not many cases are described in the literature. The f irst successful ly performed case of a replantation of total scalp avulsion was described in 1975. In most cases reported in the literature, descriptions are provided of microsurgical details as well as postoperative care procedures after replantation of the scalp. Based on international standards, the common approach is to make at least an attempt to replant the scalp.

In this report, we describe a case of a total scalp avulsion with the replantation of arterial anastomosis only (the superficial temporal arteries). The procedure was performed in North Estonia Medical Centre, Estonia, in 2010. A woman sustained a total scalp avulsion trauma while working with mechanical equipment. After microsurgical replantation, low-weight molecular heparin, medical leech therapy and hyperbaric oxygen therapy were used. During the case the main issue was related to the venous congestion of the scalp. Early postoperative signs were relatively promising: the scalp was vital and the patient was discharged with a satisfactory result. However, the infection of the scalp developed 6 weeks after the initial operation. The infected scalp was surgically excised and a free skin transplantation was performed with a good final cosmetic result.

One year later the skin graft is intact and there is no ulcer or skin necrosis of the scalp.

In this report we describe the treatment procedure in a detailed way, presenting every step of the treatment, providing also a brief literature overview and discussion.