Psychological sequelae of failed scalp replantation

Published reports of avulsed scalp replant attempts have been promising. Numerous case reports and published series have demonstrated a greater than 90 percent replantation success rate. However, there exists a paucity of articles on the management of patients following failed scalp replantation attempts. The authors recognize numerous stressors that affect these patients, including the inciting traumatic event, hospitalizations, multiple surgical interventions, postsurgical therapies, and disfigurement caused by non-hair-bearing scalp. Thus, as part of the medical management for scalp replant patients, one must address the psychological factors surrounding the medical management. Over the past 25 years, the authors have experienced four cases of scalp replant failures, each posing an opportunity to examine the postoperative course of these patients. Symptoms ranging from mild anxiety to depressive symptoms have been observed in all of these patients. In fact, patient symptoms often satisfied the criteria for major depressive disorder or posttraumatic stress disorder. The authors recognize the importance of informing patients and their families of the immediate and potential long-term complications following an unsuccessful scalp replant attempt. The authors advise that all patients be provided immediate psychiatric evaluation and, if necessary, counseling and medication therapy, regardless of scalp replantation outcome.