Management of scalp injuries.

Scalp avulsions of various origin are frequently seen, owing to rapid industrialization and the increased incidence of road-traffic accidents. This article deals with 20 such cases seen and treated by the authors in the last 5 years. The victims were predominantly young females. The anatomic and pathophysiologic aspects of avulsion injury are considered in detail, and various modalities of treatment are discussed. With intact pericranium, split-skin grafting remains the treatment of choice. In the presence of bare bone, local flap is preferred, if feasible. If not, then the outer table of the skull is chiseled out or multiple drilling is done through it to accelerate the formation of granulation tissue. Subsequently, this is covered by split-skin grafting. Of course, the grafts do not grow hair and the patients need to wear a wig for total psychological and functional rehabilitation. Prevention remains still the best remedy.