Replantation Repair of Total Scalp Avulsion

A 42-year-old woman suffered a total scalp avulsion caused by the braid involved in the rotating machine. Physical examination: The wound and alvused scalp were seriously polluted. The laceration extended from the nose root in the anterior to the occipital hair in the posterior, and it extended across the back of two ears including part of the left ear with area about 18 cm × 14 cm bone exposed. The avulsed scalp was without blood supply, and we could see a 6.5 cm × 10.5 cm contusion of the occipital region and multiple lacerations. The patient was brought to the operating room when the vital signs were stable after hemostasis by compression bandage, antishock treatment, and completing essential examinations. The avulsed scalp was replanted in situ after complete debridement by anastomosing both superficial temporal arteries and veins, both posterior auricular arteries and veins, and two occipital nerves. After the replantation, the scalp had a good blood supply, and then we sutured the wound with 3–0 silk sutures, installed the Halo-vest head ring (Fig. 37.1), placed half tube drainage, and wrapped it with sterile gauze in order. The scalp was completely alive after 72 months of follow-up, and the patient was satisfied with the hair growth and the appearance (Fig. 37.2).