Protocol of diagnosis and treatment for scalp avulsion injury / 中华医学美学美容杂志

Objective To search for a treatment approach for scalp avulsion injury based on the clinical experiences and review of literature.Methods Twenty-six consecutive scalp avulsion cases were involved in the study:15 cases were complete scalp avulsion (5 including forehead skin) and 11 cases were partial scalp avulsion.Cranial bones exposure occurred in 16 cases,11 of which had a size over 4 × 4 cm2.The treatment methods were various:11 cases with microsurgical replantation,9 cases with skin grafting,4 cases with secondary skin grafting followed by multiple drilling of the calvarium,1 case with local flap,and 1 case with free flap.According to the clinical cases and literature reviews,authors tried to search for an optimal protocol.Results Patients with microsurgical replantation achieved the best recovery including hair growth.In case of not qualified or fail to microsurgical replantation,skin graft could be considered as an alterative step,whereas the result of it was no hair growth and usually scar healing.In summary,14 different clinical conditions followed with 10 surgical techniques were concluded in a route chart.Conclusions To achieve the optimal outcomes of scalp avulsion injury,proper techniques should be chosen according to the treatment protocols.

Occupational injury at Gangsaw machine A rare occurrence.

Since last few decades, occupational injuries have been a major cause of morbidity and mortality among people working in factories, especially those working with unprotected rotating machines. Women are specifically prone to such injuries because of their long unprotected hairs being trapped in moving parts of the machines. Long hairs can get entangled in moving machinery resulting in complete or partial avulsion of scalp. A large scalp avulsion injury may lead to severe bleeding and may cause trauma to forehead, eyebrows and per auricular tissue, which may further bring fatal results aesthetically and functionally. Severe deformities as a result of this trauma may lead to severe psychological trauma, disabling the patient to lead a normal social life. Here, we are presenting a case report of a patient who had an occupational injury causing scalp avulsion with cervical spine injury at gang saw machine.

Achados tomográficos tardios nas alterações da calota craniana em pacientes vítimas de escalpelamento / Late computed tomography findings of skull changes in scalping victims by motor boat

Introdução: nos primeiros seis meses de 2011, foram registrados, no Estado do Pará, quatro casos deescalpelamento por acidentes de barco, o que corresponde a quase todos os casos registrados em 2010. Oescalpelamento é caracterizado pela avulsão total ou parcial do couro cabeludo e lesões em áreas adjacentesao mesmo, provocado pela ação mecânica do eixo giratório descoberto do motor Objetivo: descrever osprincipais achados tomográficos tardios nas alterações da calota craniana em pacientes vítimas deescalpelamento por eixo de motor de barco, atendidas na Fundação Santa Casa de Misericórdia do Pará.Método: estudo retrospectivo, reunindo dados dos prontuários e análise das imagens da tomografiacomputadorizada (TC) de 23 pacientes. Resultados: todas as vítimas eram mulheres, predominantementecrianças, sendo o trauma mais incidente na Ilha do Marajó. Na TC, foram observadas lesões de partes molesenvolvendo o couro cabeludo, com a calota craniana sendo comprometida em 100% dos casos. A lesão maisfreqüente foi a avulsão de fragmentos ósseos da tábua externa do crânio. A segunda, o comprometimento dadíploe. A lesão observada de maior gravidade foi a avulsão completa de um segmento da calota craniana.Conclusão: propõe-se uma classificação tomográfica para estes achados, segundo o grau de gravidade: grauI, correspondente à avulsão de fragmentos ósseos da tábua externa do crânio; grau II, que é ocomprometimento da díploe, podendo ser focal ou difuso; e grau III, correspondente à avulsão da calotacraniana

Introduction: There were four cases of scalping by motor boat in Pará on the first six months of 2011,which is more than all cases recorded in 2010. Scalping is characterized by total or partial avulsion of thescalp and lesions in adjacent areas, which are caused by the mechanical action of the rotating shaft of themotor boat. Objective: to describe the main late computed tomography findings of skull changes in scalpingvictims by motor boat treated at Fundação Santa Casa de Misericórdia do Pará. Methods: This was aretrospective, transversal study. The data was collected through medical records and analysis of computedtomography (CT) images of 23 patients. Results: all of the victims were female, most of them were children,and the trauma was more frequent in Ilha do Marajó. The CT images depicted soft tissue lesion involving thescalp, and the skull was affected in all cases. The most common injury was avulsed bone fragments from theouter table of skull. The second most common injury was the involvement of the diploe. The most severeinjury was the complete avulsion of a part of the skull. Conclusion: we suggest a CT classification based onthese finding, according to their degree of severity: level 1, which is the avulsed bone fragments from theouter table of skull; level 2, which is the diploe involvement that can be focal or diffuse; and level 3, which iswhen the skull avulsion is observed

Treatment of Complete Scalp Avulsion with the Conditions of Unstable Vital Signs: A Case Report

PURPOSE: Scalp avulsion is a life-threatening injury that may cause trauma to the forehead, eyebrows, and periauricular tissue. It is difficult to treat scalp avulsion as it may lead to severe bleeding. Therefore, emergency scalp replantation surgery is necessary, and we must consider the function, aesthetics, and psychology of the patients. A case of scalp avulsion leading to massive bleeding was encountered by these authors, which led to a failure to achieve the proper operation conditions in an adequate time period. METHODS: A 49-year-old female was hospitalized due to having had her head caught in a rotatory machine, causing complete scalp avulsion which included the dorsum of the nose, both eyebrows, and ears. Emergent microsurgical replantation was performed, where a superficial temporal artery and a vein were anastomosed, but the patient's vital signs were too unstable for further operation due to excessive blood loss. Three days after the microanastomosis, venous congestion developed at the replanted scalp, and a medicinal leech was used. Leech therapy resolved the venous congestion. A demarcation then developed between the vitalized scalp tissue and the necrotized area. Debridement was performed 2 times on the necrotized scalp area. Finally, split-thickness skin graft with a dermal acellular matrix(Matriderm(R)) was performed on the defective areas, which included the left temporal area, the occipital area, and both eyebrows. RESULTS: The forehead, vertex, right temporal area, and half of the occipital area were successfully replanted, and the hair at the replanted scalp was preserved. As stated above, two-thirds of the scalp survived; the patient could cover the skin graft area with her hair, and could wear a wig. CONCLUSION: Complete scalp avulsion needs emergent replantation with microsurgical revascularization, but it often leads to serious vital conditions. We report a case with acceptable results, although the microanastomosed vessel was minimal due to the patient's unstable vital signs.

Treatment of the Scalp Avulsion by Ultrasonic Surgical Aspiration

A large scalp avulsion injury may lead to severe bleeding and may cause trauma to the forehead, eyebrows and periauricular tissue. This may bring fatal results aesthetically and functionally. Severe deformity may result after treatment and may also lead to psychological trauma disabling the patient to lead a normal social life. The scalp is made up of 5 layers histologically. They are the skin, subcutaneous fat, galea aponeurotica, subepicranial space and the periosteum. The external 3 layers of the scalp exist fairly independent of the cranial bone and function as one structure in the movement of the frontalis muscle and the occipitalis muscle. Therefore, scalp avulsion injuries usually involves the 3 outer layers along with the subepicranial space but may sometimes include the periosteum as well. Treatment methods are split thickness skin graft, replantation after defatting of the avulsed flap, composite graft and microsurgical procedures. Only methods that can preserve the hair are composite graft and microsurgery. However, limitations of composite graft and the environment of the donor and degree of vessel injury of the donor may limit microsurgical procedures. The authors report 1 case of scalp avulsion injury involving the parietal area where ultrasonic surgical aspiration was used to defat the avulsed flap and grafted onto the donor site. At the time of injury, the size and degree of vessel injury of the donor site was not suitable for a composite graft or microsurgery. Therefore, an ultrasound liposuction machine(for ultrasound assisted lipoplasty) was first used on the avulsed flap before replantation after defatting to minimize hair loss. This procedure has almost no traumatic effect on hair loss and distribution and although it may decrease the density of hair follicles, it does not lead to irregular patterns of hair loss. The avulsed flap was transplanted after minimizing hair follicle injury while removing the subcutaneous fat layer of the avulsed flap. On 1 year follow-up postoperatively, although thinning of the hair and decreased density was noticed, but regrowth of the hair was confirmed.

Scalp Replantation by Arterialized Venous Anastomosis

Scalp avulsion is rare injury that has serious consequences, including hospitalization, economic loss, devasting disfigurement, and psychological effects on the patient. Microvascular surgery now allows an initial chance for successful replantation and one-stage reconstruction. The need for secondary reconstructive procedures after a successful replantation is minimal. Our one year experience with 2 patients who suffered from avulsion of partial scalp is reviewed. Each patient got long hair entangled in the uncovered rotated machines and underwent replantation using microsurgical technique. Replantations have been accomplished using only arterio-venous and venous-venous anastomosis, without arterio-arterial anastomosis in 2 cases, because of unidentification of suitable arteries. The possible explanation for the success of the operation is the paucity of valves that exist in the venous network of the scalp and forehead. The final results were good. In the follow-up period, both experienced regrowth of hair in the scalp with light touch sensation.

Application of tissue expansion in repair of scalp avulsion with skull exposure / 中华医学美学美容杂志

Objective To investigate a better method for repair of scalp avulsion with skull exposure.Methods After primary debridement and skin grafting,tissue expanders were placed into subgaleal layer of normal scalp.After enough expansion,expanded scalp flaps were used to repair the skull exposure and the bald deformity.Results All of 6 cases had satisfactory results,wounds were repaired,no bald deformity occurred and no tissue expander infected case was encountered.Conclusion Using this method,we can treat the scalp avulsion with skull exposure without bald deformity.

Traumatic avulsion of the scalp: a case report

We are reporting this case of avulsion of the scalp in order to warn women workers of the danger of not using any form of head protection while working particularly before a running machine. To management and labor unions this should also serve as a caution to make them strict in enforcing their rules and regulations. (Summary and Conclusion)