title: Multiple cranial burr holes as an alternative treatment for total scalp avulsion.
abstract: 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.
authors.affiliation: Division of Pediatric Neurosurgery, Ribeirão Preto School of Medicine, University of São Paulo, Campus Universitário, 14049-900 Ribeirão Preto, São Paulo, Brazil.
authors.forename: Luciano Lopes
authors.initials: LL
authors.lastname: Furlanetti
authors.forename: Ricardo Santos
authors.initials: RS
authors.lastname: de Oliveira
authors.forename: Marcelo Volpon
authors.initials: MV
authors.lastname: Santos
authors.forename: Jayme Adriano
authors.initials: JA
authors.lastname: Farina
authors.forename: Helio Rubens
authors.initials: HR
authors.lastname: Machado
mesh_terms: 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*
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