Surgical managements for totally avulsed scalp : Experiences in regional hospital.

Abstract

Introduction : Totally avulsion of scalp is a serious injury that is often occurred while using induatrial and agricultural machines. It generally results from entanglement of long hair in rotary machines. The best management for the sake of functional and cosmetic purpose of this type of injury is replacing the avulsed scalp with its own tissues. However, if replantation is unavailable or impossible, scalp reconstruction must be done to minimize morbidity.

Objectives : surgical managements for the patient with totally avulsed scalp

Study design : Retrospective design

Materials and methods : From year1995 to 2004, there were 5 cases that presented with totally avulsion scalp. Their ages varied from 22 to 63 years. All of them were women. They were caused by contact with agricultural machine.

Results : One case was died from multiple traumas. Four cases were survived; 2 cases for replantation (one case fail, one case succeeded), 1 case for omentum free flap, and 1 case for galeal flap plus skin graft. The succeed replantation has good hair growth and all other cases are baldness.

Conclusion : Totally avulsed scalp is associated with significant physical and psychological morbidity. Microsurgical replantation is the treatment of choice. Nevertheless, if replantation is unavailable, one stage reconstruction with well-vascularized tissue must be done. The use of surrounding galeal flap, free omentum transfer or free latissimus dorsi is also necessary. As totally avulsed is a serious injury, prevention is important.