Successful microsurgical replantation of total avulsed scalp for an 8-year-old patient

21/01/2021 08:09

On the 17^th December, 2020, Viet Duc University Hospital received on emergency one patient L.L.Đ. (8 years old, from Hai Phong province) for a total avulsed scalp due to a tricycle accident that curled her hair into the wheel.

 

Patient’s grandmother told that she was usually driven out in a tricycle. On this day, she was lying down on the back trunk. Unfortunately, her long and thick hair was caught in the wheel. The tricycle didn’t move so fast so a timely stop and proper intervention might help however the sudden panic made her sit up leading to a total avulsion of her hair and scalp from skull. When the driver heard her scream “Grandfather, save me!” and I looked back, however her scalp was totally torn out.

 

 

After a first-aid at Viet Tiep General Hospital, Hai Phong province, she was transferred to Viet Duc University Hospital, Doctor BUI Mai Anh, PhD., MD., from Maxillofacial, Plastic and Aesthetic Surgery Department, Viet Duc University Hospital shared that on admission, she was alert with a total avulsion of her scalp from one ear through forehead to the other ear and backward to the nape exposing also the skull. After checking carefully to ensure that there was no other injuries, Dr. Mai Anh and her team performed a replantation of avulsed scalp with microsurgery. A scalp replantation in pediatric patient has many difficulties because the vessels are so small, only about 0.6 – 0.7 mm in size cause  high risk of post-operative embolism so it requires high techniques and skilled surgery.

 

 

 

Dr. BUI Mai Anh, PhD., MD., shared that this total scalp avulsion was associated with traumatic skin tears upward to the crown of her head so the arteries were small leading  many challenges in making anastomosis. She performed 1 arterial and 2 venous anastomoses with microsurgical scope using the smallest sutures No.11/0

 

Associate Professor NGUYEN Hong Ha, PhD., MD., Head of Maxillofacial, Plastic and Aesthetic Surgery Department, Viet Duc University Hospital said that up to now, there is no plastic technique to regain the anatomic structure, function and also aesthetics of the scalp. The only way is immediately to replant  the avulsed scalp by microsurgical technique. Without proper intervention, patient’s skull will be exposed leading to osteoarthritis, infection and even touching the brain

Until now, in the medical literature, Viet Duc University Hospital had 30 cases of successful replantation of total avulsed scalp, one of the largest number over the world. 

 

One week after surgery, Đ.’s health condition was stabilized with hair regrowth in the replanted scalp.

 

Dr. BUI Mai Anh, PhD., MD., shared another memorial story. She performed a microsurgical scalp replantation for a female patient working in a private garment factory in Nam Dinh province. Her hair was curled into the motor and when being so panic, her boss threw both her scalp and hair into a pond. Fortunately, this factory was not so far from the hospital and the scalp was still floating so her colleagues  picked it up and brought to the hospital in time for replantation. Because she had a skull trauma in the right parietal site and a neurosurgery was required before the microsurgical replantation. The operation was performed with success and her hair grew again, however she didn’t dare to raise a long hair by her experience.

 

The hospital experts recommend in preserving the avulsed scalp before reaching the hospital : put the scalp into a clean plastic bag; Tighten up after covering it with a gauge (if available); Put into another plastic bag with water; Tighten up and put into an ice box; Keep the temperature of 4 – 10^oC; Avoid direct contact with ice it might cause a cold burn leading to vascular and nerve damages. If the body part is not total avulsed but still stuck on, do not cut it out, even when almost completely separated. Instead, cover it by bandages and put an ice bag beside to keep a quite cold temperature but avoid to put the ice directly onto the wound.