Microsurgical treatments of total scalp avulsion
10.3760/cma.j.cn114453-20200224-00074
- VernacularTitle:全头皮撕脱伤的显微外科治疗
- Author:
Ting ZHANG
1
;
Fu HAN
;
Jiaqi LIU
;
Peng YAN
;
Dahai HU
;
Juntao HAN
;
Zhao ZHENG
Author Information
1. 空军军医大学第一附属医院烧伤与皮肤外科，西安 710032
- Keywords:
Microsurgery;
Replantation;
Omentum;
Scalp avulsion
- From:
Chinese Journal of Plastic Surgery
2020;36(6):650-654
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the treatment of total scalp avulsion with microsurgery and its clinical effects.Methods:From December 2013 to November 2019, four patients who suffered from total scalp avulsion were admitted in the Department of Burns and Cutaneuos Surgery, the First Affiliated Hospital of the Air Force Medical University. All cases were female, aged 31-56 years old and with varying degrees of cranial exposure, and were treated through microsurgery for scalp repair and reconstruction. 1 case received in situ replantation of the avulsed scalp by microvascular anastomosis 24 h after injury. 2 cases with different degrees cranial bone exposure and without the indication of replantation received free latissimus dorsi flap transplantation for covering the cranial wound, and biological dressing for covering the latissimus dorsi flap and other scalp defect wound. After that, the wound was repaired with intermediate split thickness skin grafting in second stage operation. 1 patient, who was admitted to our unit with necrosis of the total scalp after direct suturing in a different unit, was treated with microsurgical transplantation of laparoscopically harvested free omentum, and covered the omentum with biological dressings, combined with second stage skin grafting.Results:All cases were followed up for 2 months to 3 years. 1 case who was treated with in situ replantation of the avulsed scalp with microvascular anastomosis had satisfactory scalp survival, good hair regeneration and no obvious scar formation. After free latissimus dorsi flap transplantation combined with autologous skin grafting in 2 cases, the head was relatively bloated, with scarred scalp and hair loss, as well as high donor site morbidity. The case, who received free omentum transplantation combined with autologous skin grafting, was plump and smooth in head appearance and soft in texture. There was little morbidity to the abdominal donor site and no obvious abdominal complications.Conclusions:In situ replantation with microsurgical anastomosis is the best choice of total avulsed scalp. For the cases with extensive cranial wounds and no indication of replantation, free latissimus dorsi flap and laparoscopically harvested free greater omentum transpltantion combined with autologous skin grafting also could obtain satisfactory clinical effects.
