Scalp avulsions and review of successful replantation

Microvascular surgery has greatly altered the handling of scalp avulsions. Review of the injury mechanism and of successful replantations has yielded some basic axioms concerning treatment of this tragic injury. Generally, larger avulsions contain vessels that are easily identified and anastomosed, and therefore have a better prognosis. Long periods of ischemia do not appear to threaten graft viability. The superficial temporal artery is the most reliable artery for scalp replantation; accompanying veins can normally be used for venous drainage, though vein grafts are often needed due to vessel disruption at injury. Replantation should be attempted with all scalp avulsions, though the size of the defect and its location will affect the outcome.