Experience of replantation and reconstruction in total scalp, partial forehead, and ear avulsions
Case report published in J Craniofac Surg (2019)
Abstract
In this study, the authors present the challenges of replantation and management of 2 patients who have total scalp, partial forehead and ear avulsion. A 39-year-old male farmer was admitted to the emergency room with the total scalp, forehead, partial right eyebrow and upper eyelid amputation after his hair was catched by an agricultural machine. Anastomoses of 2 arteries and 2 veins in the occipital region were done first. Anastomosis of the right and left superficial temporal arteries and veins were performed end to end by turning the operating table without moving the head, followed by 1 vein anastomoses in the frontal region. Although anastomotic blood flow was observed by Doppler ultrasonography, there were changes suggesting necrosis in the frontal and both temporoparietal regions and later in the occipital region. Necrotic tissues began to be debrided tangentially from the 10th day. During serial debridement, it was observed that the necrotic tissue includes skin and connective tissue. At the end of the post-operative second month, surgical treatment was completed and 12 months after the surgery, the patient lives with the wig because of hair loss, but the patient is cosmetically satisfied. An 18-year-old female gatherer was admitted to the emergency room with the total scalp, both eyebrows, right upper eyelid and partial right ear avulsion, after her hair was catched by an agricultural machine. Totally, anastomoses of 4 arteries and 3 veins were performed. On the 10th post-operative day, necrotic skin findings appeared and serial debridement were performed and it was revealed that aponeurosis was fully intact. The defect areas of skin and connective tissue were repaired with STSG. Intact partial temporal scalp tissue was present. Scalp replantation should always be considered as the first choice, according to the similar tissue principle of tissue repair in plastic surgery if there is no contraindication. Additionally, performing multiple arterial and vein anastomoses, evaluating the patient position in the post-operative period for anastomosis and hemodynamic follow-up, avoiding aggressive debridement and early reconstruction may give the patient the chance of skin grafting which is the basis of the reconstructive ladder.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Two cases of total scalp avulsion combined with forehead and ear avulsions managed with multi-vessel microsurgical replantation, serial debridement, and STSG. Long-term satisfactory outcomes.
Why This Matters for Hirudotherapy
This article presents two cases of total scalp avulsion (with varying forehead, eyelid, and ear involvement) treated by microsurgical replantation using multiple arterial and venous anastomoses, followed by management of necrosis through serial debridement and skin grafting. The authors advocate scalp replantation as first choice, with attention to multiple anastomoses and hemodynamic monitoring. The relevance to ASH's domain is indirect: these are complex replantation cases in the surgical setting where medicinal leeches are sometimes used for venous congestion, but leeching is not mentioned in either case. No data on leech therapy, outcomes related to leech use, or the secretome are provided. The article is a two-patient case report, limiting generalizability.
Citation
Experience of replantation and reconstruction in total scalp, partial forehead, and ear avulsions.
Dadaci M et al. · The Journal of craniofacial surgery, 2019
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