Multiple cranial burr holes as an alternative treatment for total scalp avulsion.
BACKGROUND
Total scalp avulsion is a devastating injury in clinical practice. It often occurs in female adults, being rare in children. The standard treatment for scalp avulsion is microsurgical replantation, when feasible. Coverage becomes a major problem when replantation fails or is contraindicated, resulting in significant morbidity and requiring multiple procedures. In this article, in addition to reviewing the literature, we report a historical method for obtaining skin coverage after failure of replantation.


METHODS
The authors report a case of a 10-year-old girl who had her scalp totally avulsed by an agricultural machine, including her right auricle. Microsurgery scalp replantation was attempted immediately after fluid resuscitation. The surgery failed probably due to the long time interval between trauma and surgery, which resulted in total ischemic time of 11 h and consequently made vascular microanastomosis impracticable. Multiple trephination of the calvarium was performed in order to expose the diploe. After 4 weeks, granulation tissue from the holes began to cover the defect, allowing the formation of a vascular bed suitable for skin grafting.


CONCLUSIONS
Total scalp avulsion in children is seldom reported in the literature. Therefore, its management is both difficult and challenging. The exposure of the diploe with multiple burr holes is a safe and effective method for treating this injury. It may be considered, along with skin grafting, a good therapeutic alternative to be used when microsurgical replantation fails or is not feasible.
Furlanetti
Luciano Lopes
LL
Division of Pediatric Neurosurgery, Ribeirão Preto School of Medicine, University of São Paulo, Campus Universitário, 14049-900 Ribeirão Preto, São Paulo, Brazil.
de Oliveira
Ricardo Santos
RS
Santos
Marcelo Volpon
MV
Farina
Jayme Adriano
JA
Machado
Helio Rubens
HR
D002648:Child; D005260:Female; D006801:Humans; D008866:Microsurgery / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012535:Scalp / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D016038:Skin Transplantation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014207:Trephining / Q000379:methods*
J Trauma. 2008 Mar;64(3):796-802
18332826
Br J Plast Surg. 1952 Apr;5(1):37-50
14944771
Ann Surg. 1950 Aug;132(2):198-213
15433188
J Oral Maxillofac Surg. 1999 Feb;57(2):204-6
9973134
Br Med J. 1933 Jan 7;1(3757):13-46.4
20777279
Plast Reconstr Surg. 1983 Dec;72(6):786-90
6647601
Ann Plast Surg. 2000 Aug;45(2):118-21
10949336
Ann Surg. 1914 Feb;59(2):186-90
17863140
Plast Reconstr Surg. 1985 Aug;76(2):189-94
3895261
Br J Plast Surg. 1986 Jul;39(3):417-21
3730695
Plast Reconstr Surg. 1976 Aug;58(2):133-6
940866
J Craniofac Surg. 2009 Jan;20(1):81-4
19164996
Plast Reconstr Surg. 1996 May;97(6):1099-106; discussion 1107-8
8628792
Ann Surg. 1904 Nov;40(5):644-9
17861541
Scand J Plast Reconstr Surg. 1986;20(3):319-22
3589515