Replantation of total avulsed scalp with microsurgery: experience of eight cases and literature review.
BACKGROUND
Reports in the literature about scalp replantation are mostly sporadic; rarely can one find a large series. We present our experience with eight cases of scalp amputation replanted microsurgically.


METHODS
From 1992 to 2003, eight patients who sustained scalp amputation injuries underwent microsurgical replantation. Age ranged from 3 to 46 years (average, 27.3), and four patients were male. The scalp amputations in the three adult male patients were sustained from cutting incidents by a blade, whereas those in the four female patients were from their long hair getting caught in a roller machine. A 3-year-old boy suffered scalp avulsion from a dog bite. A vein graft was needed in four patients whose scalp injuries resulted either from avulsion or a dog bite, which was not deemed necessary for those sustained by cutting injuries.


RESULTS
Seven of the eight replantations were successful. The failed replantation in this series was the case where only arterial revascularization was performed, which resulted in venous congestion. Rotation scalp flap was placed to cover the defect. A boy who sustained scalp amputation from a dog bite suffered partial necrosis of the replanted scalp, which was covered with a skin graft. The resulting alopecia area was eventually excised after tissue expansion.


CONCLUSIONS
Successful replantations can achieve the best esthetic and functional results compared with other procedures. Scalp amputations sustained from sharp cuts seem to be quite as common as hair traction injuries. Such amputation injuries were more common in male patients with short hair. The manner of injury often will influence planning during replantation. Even if the amputated scalp was crushed or contaminated, such as those sustained from animal bites, replantation should still proceed, unless a greater contraindication exists.
Yin
Jir-Wen
JW
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Matsuo
Jeannette Marie S
JM
Hsieh
Ching-Hua
CH
Yeh
Ming-Chung
MC
Liao
Wen-Chieh
WC
Jeng
Seng-Feng
SF
D000293:Adolescent; D000328:Adult; D000818:Animals; D001733:Bites and Stings / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012092:Replantation / Q000379:methods*; D012535:Scalp / Q000098:blood supply / Q000293:injuries* / Q000601:surgery*; D013524:Surgical Flaps; D015626:Tissue Expansion / Q000379:methods