Replantation of total avulsed scalp with microsurgery: experience of eight cases and literature review.

Background: Reports in the literature about scalp replantation are mostly sporadic; rarely can one find a large series. We present our experience with eight cases of scalp amputation replanted microsurgically.

Methods: From 1992 to 2003, eight patients who sustained scalp amputation injuries underwent microsurgical replantation. Age ranged from 3 to 46 years (average, 27.3), and four patients were male. The scalp amputations in the three adult male patients were sustained from cutting incidents by a blade, whereas those in the four female patients were from their long hair getting caught in a roller machine. A 3-year-old boy suffered scalp avulsion from a dog bite. A vein graft was needed in four patients whose scalp injuries resulted either from avulsion or a dog bite, which was not deemed necessary for those sustained by cutting injuries.

Results: Seven of the eight replantations were successful. The failed replantation in this series was the case where only arterial revascularization was performed, which resulted in venous congestion. Rotation scalp flap was placed to cover the defect. A boy who sustained scalp amputation from a dog bite suffered partial necrosis of the replanted scalp, which was covered with a skin graft. The resulting alopecia area was eventually excised after tissue expansion.

Conclusion: Successful replantations can achieve the best esthetic and functional results compared with other procedures. Scalp amputations sustained from sharp cuts seem to be quite as common as hair traction injuries. Such amputation injuries were more common in male patients with short hair. The manner of injury often will influence planning during replantation. Even if the amputated scalp was crushed or contaminated, such as those sustained from animal bites, replantation should still proceed, unless a greater contraindication exists.