Successful replantation of two avulsed scalps by microvascular anastomoses

Two cases of immediate replantation of avulsed scalps by microvascular anastomosis are presented. This method of treatment seems to offer significant economic, social, and psychological advantages over split-skin grafting of the calvarium, or other presently used treatments. The need for secondary reconstructive procedures after a successful replantation is minimal, or nil. The mechanism of scalping is reviewed, and it is related anatomically to the structure of the galea aponeurotica. Specific recommendations are made regarding the immediate care of the avulsed scalp and the denuded calvarium, the value of a team approach in replantation, and various technical aspects of the procedure and postoperative management. The more frequent use of interpositional vein grafts is urged.