Factory machine accident
A 26-year-old woman was brought to the emergency department via ambulance approximately four hours after a traumatic injury. Her hair was caught in a factory machine, resulting in avulsion of the entire hairy scalp, nasal area, forehead, left ear, and bilateral eyelids and eyebrows. There was no loss of consciousness. The examination ruled out associated life-threatening cervical dislocation and intracranial injuries. After fluid resuscitation and 1000 ml blood transfusion, the patient was brought to the operating room for immediate replantation under general anesthesia. Debriding the avulsed scalp, preparing the recipient site of the patient’s head, and harvesting venous grafts from the lower extremity were carried out simultaneously. The avulsed scalp was placed on the underside of an overturned circular basin, carefully shaved and debrided. It was also thoroughly irrigated to remove dirt and oil. The only vessels available for microanastomoses were the bilateral superficial temporal artery and veins. Vein grafts were anastomosed to the arteries on the patient’s head and veins on the avulsed scalp at the same time. Immediately after replantation and anastomosis of the completely avulsed scalp, excellent blood supply was established for all of the avulsed tissue. Total ischemia time was 10 hours. The dressing was changed initially four days after surgery; the scalp survived well and closed drains were removed at this time. Twenty days after the surgery, the scalp was seen to have survived well, and hair developed gradually. Two and a half years after the accident, anterior and posterior views revealed that the entire hair-bearing scalp survived well. Credit: Zhaohua Jiang, M.D., Shengli Li, M.D., Weigang Cao, M.D., Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital
