Total Scalp Replantation: Staged Reconstruction of Occipital Necrosis With Tissue Expansion

Total scalp avulsion is a rare but devastating injury that can lead to significant functional and aesthetic morbidity.Microsurgical replantation is considered the treatment of choice when technically feasible;however, complications such as partial necrosis may occur despite successful vascular anastomoses. We report a case of scalp replantation in a 15-year-old girl who sustained total scalp avulsion after her hair became entangled in agricultural machinery.Following successful replantation, partial necrosis developed in the occipital region.Serial debridement demonstrated that the necrosis involved the skin and subcutaneous tissue while the galea aponeurotica remained intact.The defect was temporarily managed with split-thickness skin grafting.In the delayed stage, tissue expansion was performed in the adjacent viable replanted scalp, followed by excision of the grafted alopecic area and reconstruction using expanded hair-bearing scalp. This staged approach provided stable wound coverage and enabled restoration of hair-bearing scalp, representing an effective salvage strategy for partial necrosis after scalp replantation.