Successful Scalp Replantation

SavageGlow · #1 ● 07-24-2024, 08:48 PM

Successful Scalp replantation on a patient after her hair was caught in a laundry-packing machine resulting in complete scalp amputation.

A 47-year-old woman presented to the hospital with a com- plete amputated scalp after her hair was caught in a laundry-packing machine.

Upon arriving at the hospital, the patient received an initial evaluation and was stabilized in the emergency room. The pa- tient was immediately transported to the operating room after examination and exclusion of any other associated life-threatening injuries. The amputated scalp was rinsed with saline, and the total ischemic time was approximately 4 hours. The surgical procedures were performed under general anesthesia and distal vessels were identified under an operative microscope.

MLT (three to four leeches per time) was performed four to six times a day to relieve venous congestion to maintain blood flow, and chemical leech therapy of 2-mg subcutaneous LMWH (40 mg of enoxaparin sodium; Clexane, Sanofi, Paris, France) was injected three times a day for 2 weeks after reanastomosis to manage severe venous congestion (Fig. 2).

The scalp mostly survived. However, partial skin necrosis developed in the lower left occipital area region. Therefore, the le- sion was debrided and reconstructed with a split skin graft 2 weeks after the operation. Exuberant hair was evident 2 months after the first operation, but the patient’s hair growth pattern was different on the sides. The right temporal area had greater hair growth compared with the occipital and the left temporal area of the scalp.

At 3 years postoperative, hair had grown sufficiently in the rest of the scalp; approximately 85% of scalp flaps except the lower left occipital area of the scalp (Fig. 3). Several scar revisions were done on the neck and eyebrow for better aesthetic outcomes during 2 years postoperative.