Total scalp replantation--salvage following prolonged ischaemia with poor prognostic factors

Case report of a salvaged total scalp, forehead, ear and cheek en-bloc replantation following an industrial avulsion injury with a warm ischaemia time of over 12 h. One arterial and two venous anastomoses using an interposed arterial graft instead of a vein graft was sufficient to produce a successful result. The patient was followed up for a two-year period. Scalp amputations can result in devastating disfigurement and psychological trauma especially in young female patients. The authors present a case with an unusually long ischaemia time in addition to several other poor prognostic factors. The key learning point and message here is that microvascular replantations achieve by far the best aesthetic and functional results compared with other procedures and should be attempted at all possible costs.