The microsurgical replantation of seven complete scalp avulsions: is one artery sufficient?

BACKGROUND: Total scalp avulsion is a rare and devastating event. Microsurgical replantation is the sole method to achieve an ideal cosmetic outcome. In the literature, most studies have reviewed limited sample sizes. Most authors report better outcomes when a greater number of microvascular anastomoses are used. This strategy remains controversial, as some authors have suggested that one artery may be sufficient.
METHODS: From 2005 to 2008, seven patients who sustained scalp avulsion underwent microsurgical replantation. All of the vascular anastomoses were made with a branch of the superficial temporal artery. We did not use vein grafts. The ischaemia time was 4-16 h.
RESULTS: In six cases, a single artery and one to two veins were anastomosed; in another case, two arteries and three veins were anastomosed. Six of the seven scalp replantations were successful and achieved normal hair regrowth. In five of the six successful cases, we performed a single-artery anastomosis.
CONCLUSION: Scalp avulsion is rare around the world but occurs relatively frequently in our country due to the lack of safe and secure working conditions in agriculture and industry. In cases where multiple arterial anastomoses are not possible, the present findings suggest that one branch of the superficial temporal artery may be sufficient to reperfuse the replanted scalp and achieve excellent aesthetic results.