Discussion
Complete scalp avulsion is a rare and life-threatening injury typically resulting from the entanglement of long hair in rotating machinery, such as agricultural or industrial equipment. Various treatment methods for scalp avulsion include thinning the scalp into medium-thick skin flaps and replanting them in situ[5]. However, the success rate of this method is relatively low. For cases with exposed cranial bones, skull perforation can be performed, and skin grafting is done after granulation tissue formation. Another approach involves using the greater omentum for free transplantation to the head, with skin grafting on the greater omentum[6-7]. However, these methods may result in alopecia deformities. With the advancement of microsurgical techniques, utilizing vascular anastomosis for full scalp replantation is considered the best method for treating scalp avulsion injuries. This approach ensures blood supply to the scalp and promotes hair regrowth, typically avoiding alopecia deformities.
The scalp receives a generous supply of blood from various arteries located in the subcutaneous layer above the galea, including the superficial temporal, occipital, supraorbital, and supra-auricular arteries. If postoperative drainage is inadequate, leading to the formation of a subgaleal hematoma, it can cause separation of the scalp and ultimately result in the failure of scalp replantation. Therefore, preventing scalp separation is key to ensuring scalp replantation’s success. In this work, we have refined the technique for fixing the scalp, presenting a novel method that secures the scalp sporadically using a spider-web-like design. First of all, spider web anchoring of the scalp efficiently prevents displacement of the scalp during or after surgery, which could lead to vascular rips, breaks, anastomotic distortion, and the production of large subcutaneous hematomas after surgery. It also makes intraoperative vascular anastomosis easier. Second, it makes it easier for the recipient site and the replanted scalp to come into close contact, which promotes the development of a shared blood supply. Finally, it lessens subcutaneous oozing, successfully stopping hematomas from forming under the scalp. As a result, the enhanced scalp fixation technique can significantly increase the success rate of replantation.