Scalp avulsion is the most severe type of scalp injury, often caused by hair being caught in a high-speed rotating machine. Due to the tight connection between the skin, subcutaneous tissue, and the galea aponeurotica, strong traction can result in complete avulsion of the scalp from the subgaleal space, sometimes even involving part of the pericranium. In severe cases, the entire scalp, including the frontal muscles, may be avulsed. Significant blood loss can lead to hemorrhagic shock, requiring prompt treatment.
The management of scalp avulsion depends on various factors, including the time since injury, whether the avulsion is complete, the condition of the avulsed scalp, whether the skull is exposed, and the presence of infection. Different approaches are employed based on these factors:
If the skin flap is only partially detached and still has good blood supply, debridement is performed, followed by primary closure.
If the skin flap has completely detached but remains intact, shows no significant contamination, has clean vascular stumps, and the injury is within 6 hours, microsurgical anastomosis of scalp vessels (such as supraorbital arteries and veins, superficial temporal arteries and veins, or occipital arteries and veins) is performed after debridement, followed by full-thickness closure of the scalp.
If the avulsed flap is unsalvageable due to contusion or contamination, and the pericranium is still intact, free skin grafting or a pedicled flap can be used. If the pericranium is damaged and the skull is exposed, local fascial transfer is performed first, followed by skin grafting.
In cases of prolonged avulsion, infected wounds, or failed previous treatments, the wound is initially cleaned and dressed. Skin grafting is performed once granulation tissue has formed. If the skull is exposed, multiple burr holes are drilled through the outer table of the skull, and skin grafting is performed once granulation tissue has formed at the burr hole sites.