Total scalp replantation salvaged by changing the recipient vein

Successful replantation of the avulsed scalp has been reported by a number of authors, and there seems almost no doubt that each single superficial temporal artery and vein is enough to feed and drain the whole scalp if the amputee is not severely torn. As the venous problem is the most common cause of failure, efforts have been made to anastomose reliable veins for drainage. We report a case of total scalp avulsion that was, at first, fed and drained by a superficial temporal artery and an ipsilateral supraorbital vein. Congestion progressed slowly, and exploration revealed patent venous anastomosis without apparent thrombosis. Congestion was relieved when the recipient was changed to superficial temporal vein using a vein graft, leading to complete survival of the scalp. We propose the importance of the capacity of recipient vein, in addition to the anastomotic patency, for successful replantation of the whole scalp. We assume that the capacity of a small caliber recipient vein may be limited even in full dilatation, and the importance of the competent recipient vein should not be overlooked in a large amputee replantation or a large free flap surgery.