Overcoming Prolonged Ischemia in Total Scalp Avulsion After Industrial Accident: A Case Report

BACKGROUND Total scalp avulsion is a rare but severe injury, commonly associated with industrial accidents. Historically, treatment options have been limited, with poor outcomes in terms of tissue survival and functional recovery, especially in prolonged ischemic time, which can lead to a cascade of events, including thrombosis and necrosis. Microsurgical replantation, however, has proven to be a more effective technique, offering improved results in tissue viability and patient recovery. This case report highlights the success of microsurgical intervention in treating scalp avulsion injuries, even under challenging circumstances, such as prolonged ischemic time. CASE REPORT A 28-year-old woman had a total scalp avulsion when her hair became caught in machinery at a fiber tractor factory. She was admitted to the hospital 4 h after injury, and the avulsed scalp was successfully replanted 7 h after initial trauma. The surgical team performed bilateral anastomosis of the superficial temporal arteries and veins. Despite prolonged ischemic time, most scalp tissue survived, with only a small area of partial necrosis developing in the right occipital region. This was later treated with debridement and split-skin grafting. Follow-up revealed promising results, including substantial hair regrowth and recovery of sensation in the affected areas. CONCLUSIONS This case illustrates the effectiveness of microsurgical replantation for treating total scalp avulsion, even in cases of extended ischemic time. Prompt surgical intervention, with appropriate postoperative care, is critical to achieving favorable outcomes. Preventive measures, such as the use of protective helmets in occupational environments, are essential in reducing the risk of such injuries.