Microsurgical replantation of two totally avulsed scalps

We describe our experience with two patients in whom total avulsion of the scalp occurred. Successful replantation was carried out by microvascular surgery, with 90 and 95% survival of the scalp. Normal hair regrowth and ability to raise the eyebrows was achieved in both cases. A single superficial temporal artery was anastomosed, providing excellent perfusion of the entire scalp. Microvascular replantation should be attempted with all scalp avulsions, regardless of appearance and mechanism of injury. The patient must be transferred to a medical center with comprehensive microvascular surgery capabilities. The avulsed scalp should be cooled to 4 degrees C immediately, but prolonged ischemia time does not preclude a successful result.