Two cases of scalp reimplantation based on one artery and one vein with interposed vein grafts

The authors report their experience in successful reimplantation of avulsed scalp in two patients with one arterial and one venous anastomosis to the superficial temporal vessels. In both cases a double vein graft, harvested from the dorsum of the hand, was interposed between the pedicle of the scalp and the recipient temporal vessels to avoid tension after trimming of the damaged segments. Scalp replantation based on two or more vessels has previously been reported in the literature. In the present cases, the complete survival of the scalp on only a single vascular pedicle suggests that replantation should be considered also when the available vessels for the anastomosis are few. Moreover, even if these reconstructions are lengthy, a prolonged ischemic interval does not appear to be a significantly limiting factor for the success of the revascularization. The cosmetic and psychological success of these cases lend support to the idea that one should always attempt a microvascular replantation of avulsed scalps.     

Microsurgical replantation of the scalp

Our 7-year experience with seven patients who had suffered avulsion of 30% or more of the scalp is reviewed. Six of the seven, who were candidates for microsurgical replantation, underwent successful replantation with 100% survival in five, and 50% survival in one. All had luxuriant regrowth of hair. The mechanisms of injury, emergency management, indications, and operative techniques are discussed. The role of interpositional vein grafts, and choice of vessels in contributing to this success is emphasized. The superiority of replantation over other methods of reconstruction of major scalp defects is demonstrated.     

吻合动静脉与只吻合动脉的Ⅲ型末节断指再植的对照研究

目的观察末节Ⅲ型断指再植中吻合动静脉与只吻合动脉的临床病例对照。方法2000年1月-2007年12月收治的174例213个Ⅲ型末节断指,根据吻合血管的不同分为A,B,C三组,A组104指吻合了指腹静脉,B组44指近端指腹静脉与远端动脉做动脉静脉化,C组65指未吻合静脉。比较再植成活率和术后血管危象发生情况。结果本组总成活率923％。重建静脉回流的148指成活144指,成活率97．3％;未重建静脉回流的65指成活53指,成活率81．5％。有统计学差异。结论重建静脉回流可有效提高Ⅲ型末节断指再植成活率、减少静脉危象的发生。     

Successful replantation of a totally avulsed scalp

A case of successful replantation of a totally avulsed scalp in a 19-year-old woman is presented. Although severely traumatized, about 90 percent of the surface of the replanted scalp survived. Only one artery (left superficial temporal) and four veins were anastomosed, sufficient enough to revascularize the entire scalp.     

Microvascular replantation of a completely avulsed scalp

Total scalp avulsion is an unusual injury. To obtain good functional and cosmetic results, immediate revascularization using microsurgical techniques and replacement of the scalp in the correct anatomical position is the procedure of choice. This article describes a case report of successful replantation of a totally avulsed scalp from a 26-year-old male. Bilateral superficial temporal vessel anastomoses were performed using reversed autologous long saphenous vein grafts on the right side and direct repair on the left. Points of technique are discussed and the literature is reviewed. © 1994 Wiley-Liss, Inc.     

Successful replantation of a totally avulsed scalp.

A case of a totally avulsed scalp was replanted successfully by microvascular anastomosis. Though the avulsed part was heavily crushed, which resulted in a central wound, the appearance of a "necrotic" area, haematomas and persistent serous exudation after the restoration of circulation, the whole scalp survived.     

Technical considerations in replantation of total scalp avulsions.

Total scalp avulsions are devastating injuries and replantation is the best form of reconstruction. We present our experience of replantation of six totally avulsed scalps done between 1996 and 2004. All were technically successful, but one was lost in the post-operative period due to accidental shearing of the scalp during nursing care. A single team performed the surgery in all cases and the average operating time was 6 h. No vein grafts were used. Hair growth was satisfactory in all cases. None underwent formal nerve repair but there was adequate sensory recovery in all of them by 6-9 months. A small area of skin necrosis in the occipital area (three cases), telecanthus and epiphora (two cases) were the minor complications. The available Literature highlights the need for multiple teams to reduce the long operating time, the use of multiple vein grafts and the complexities involved. Since, they are rare injuries, gaining wide experience is difficult. In this article we offer recommendations in pre-op preparation, vessel identification, technique of anchoring the avulsed scalp prior to vessel anastomosis and post-op care to make this rare procedure quicker, easier and successful.     

First successful replantation of face and scalp with single-artery repair: model for face and scalp transplantation

Successful replantation of the scalp with microanastomosis of a single artery and vein has been reported to produce reliable results. In fact, there have been several reports of scalp replantations based on one-artery and vein repair. There has been a face and scalp replantation reported in the literature, but this was as two separate parts and was based on several arterial and venous repairs. The authors performed the first successful replantation of a face and scalp with repair of a single artery and, of course, two veins. A 21-year-old man presented after his face and scalp were completely severed. The patient's long hair was caught in a conveyor belt at work. The face and scalp underwent replantation, with repair of the right superficial temporal artery with an interposition vein graft. A multiteam approach allowed for minimization of overall ischemic time and simultaneous preparation of the vessels on the patient and amputated part as well as vein graft harvest from the arm. Also critical to the success of the procedure, the small portions of the vessels of the amputated part were sent for frozen section to differentiate artery from vein. Initially, only the right superficial temporal vein was repaired. One week after replantation, the patient returned for treatment of venous congestion of an area to the opposite side of the forehead partial transection, with repair of the left superficial temporal vein, also. This saved the entire part that underwent replantation, and the entire part survived. The face and scalp can undergo replantation based on single-artery repair.     

全头皮撕脱伤原位再植术的护理配合

目的探讨全头皮撕脱伤原位再植术的手术室护理要点。方法对10例全头皮撕脱伤患者进行撕脱头皮原位再植术。给予术前积极心理支持、快速有效扩容,术中体温保护、严格的空间、感控管理以及显微器械等物品的精细管理,术后规范转运。结果10例患者手术均成功,术后32~85d出院,效果满意。结论有效的心理支持、早期抗休克、保护体温和严格的术间管理、熟练规范的手术配合是全头皮撕脱伤原位再植术成功的关键。     

Fingertip replantation: Pre-osteosynthesis vein graft technique

Since 1985 we have been performing replantation of amputated fingertips using a pre-osteosynthesis vein graft technique. First, we locate an artery and vein at the distal part of the fingertip and perform a vein graft. After this, we perform osteosynthesis. Since there is sufficient vessel length, the anastomosis technique becomes easier than with the method previously used. In our department, between 1985 and 1990 we performed 11 Zone I replantations. Ten fingers survived and one failed. There were good results in seven cases and three had fair results. The pre-osteosynthesis vein graft technique is a reliable technique for amputated fingertip replantation. © 1994 Wiley-Liss, Inc.     

Avulsion of the scalp: which one is the best artery for anastomosis?

We present a patient who underwent successful replacement of a large avulsed scalp with microvascular anastomosis of one artery and three veins. The left occipital artery in the avulsed scalp and a frontal branch of a right superficial temporal artery in the recipient forehead were anastomosed. Three veins in the occipital area in the avulsed scalp were anastomosed via vein grafts to three veins in the frontal area, respectively. For successful replacement, the selection of the vessels depends on each individual case. To give easy anastomosis, a good cosmetic result, and a comfortable postoperative period, it is not always necessary to reconstruct a previously normal anatomical position.     

Neurotization of the frontal muscle after scalp replantation: case report

A case of immediate replantation of an avulsed scalp by microvascular anastomosis is presented. Microvascular replantation of the scalp seems to offer significant social and psychological advantages over secondary reconstructive procedures. The significance of the case presented is the regaining of the motor neural function of the facial nerve after 38 months.     

Microsurgical replantation of complete scalp avulsion: a five year follow-up

Summary A 19-year-old woman sustained total scalp avulsion. Replantation of the avulsed scalp by microvascular anastomoses was successfully performed on October 10, 1976. A follow-up evaluation after 5 years is presented.     

逆行法吻合掌侧静脉的指尖再植

目的探讨手指指尖离断的治疗。方法根据田万成指尖分型法,并运用逆行法对指尖离断行吻合掌侧静脉的再植手术。结果本组452例568指,成活542指,成活率95.4%术后随访2～10年,手指长度同健侧相似,外形满意,功能良好。结论手指尖离断绝大多数可找到可供吻合的掌侧静脉,逆行法指尖再植对吻合掌侧静脉极为方便。