The Comparison Of Therapeutic Methods In Scalp Avulsion

Background and objectivesThe scalp avulsion is a serious mechanical trauma, which was caused by hair involving in the high speed rolling machine. The complete avulsions always have psychological and physical influence on the patients.There are various therapeutic methods to treat scalp avulsion, which lead to different plastic effects and rates of success. But the incidence of scalp avulsion is so rare that only case reports were collected in literature when comparing with other traumatic diseases. In this paper, 31 reports were summarized and 275 cases were analyzed retrospectively in order to provide guidelines for the treatment of scalp avulsion.MethodsLiteratures were collected and statistical analysis was done. 275 cases were summarized from 31 case reports on CNKI from 1994 to 2005. The most common therapeutic methods, frequency of intercurrent syndromes and the number of arteries and veins anastomosed were counted and analyzed via SPSS 11.0. Results1. Scalp replantation by microvascular anastomosis and skin graft from the scalp are the most common therapeutic methods among the 275 cases, which take up 26.18% and 34.91% and the successful chance are 80.56% and 93.75% respectively. And the different rate of success is significant. Totally necrosis occurred in about 12.00% of replantation without vessel anastomosis.2. Among all the incurrent syndromes, cranium exposure (33.82%), ear avulsion (20.73%), forehead avulsion (13.82%) and shock (16.00%), which is caused by excessive blood loss are common. Others are rare comparatively.3. The scalp replantation is the best method to treat scalp avulsion. It can make the patient has new hair and give them opportunity for secondary scalp expansion. So the indications should be enlarged to some extend. The statistical analysis indicated that anastomosis of one or two arteries had the same result on the basis of effective anastomosis. Also the group with 1:1 ratio of artery to vein is the most common case, whose successful chance is significantly higher than group with 1:2 ratio. And vein anastomosis should be done in case of vessel shortage, which accounts for 41.67%.4. The successful chance of skin graft from the scalp group is significantly higher than the replantation group. But it leaves behind life-long calvities. It's unsuitable for the cranium exposure cases. About 53.66% of the cases need secondary operation.Conclusions1. Scalp replantation by microvascular anastomosis is the best therapeutic treatment for scalp avulsion. In scalp replantation, single superficial temporal artery and 1:1 ratio of artery to vein should be anastomosed at least. Skin graft from the scalp is a usual and reliable therapeutic method. Do not replant the scalp without microvascular anastomosis. There is no chance to succeed. 2. In all the intercurrent syndromes, cranium exposure is the most common. Ear and forehead avulsions are the most probably additional avulsed parts. Shock can also occurre more often than the other traumatic lesions.3. Cranium exposure would increase the operating times. So it should be cured during emergency operation.