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Total Scalp Replantation: Surgical Tricks and Pitfalls
Serdar Nasir1, Mehmet Karaaltin, Adnan Erdem
1*Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University, Ankara †Department of Plastic, Reconstructive and Aesthetic Surgery, Bezmi Alem Vakif University, Istanbul ‡Private Practice, Bursa, Turkey.
Background:
Two patients were successfully operated on for total scalp avulsions.
Methods:
Ages were between 11 and 35 years, and both patients were female. Bilateral temporal artery and veins were used as the recipient pedicles. Interpositional vein graft harvested from the left forearm was used in 1 patient. No nerve repair was performed.
Results:
The scalp was successfully replanted in both cases. Venous congestion and arterial insufficiency were observed in 1 patient. Successful revision of the vascular anastomosis was performed. Total necrosis of the upper helical rim was observed in 1 patient. A mean size of 3 × 3 cm of tissue necrosis was observed in the occipital region of all patients. One patient was treated with split-thickness skin grafting, whereas the other one was left for secondary healing.
Conclusions:
The "replace like tissue with like tissue" represents the philosophy in replantation surgery. Although reconstructive surgeries imply advanced surgical methods, scalp replantation remains the only ideal surgical modality to create an embellishing natural-looking hair-bearing scalp. In this article, we present some tricks and pitfalls of total avulsed scalp replantation as well as our skills and literature review.
