Scalp Avulsion Injuries and Replantation: Is Deep Temporal Artery an Alternate Option?

Scalp avulsion injuries are usually attributed to entrapment of long hair or clothing in agricultural or industrial machinery or traffic accidents. Though rare, these injuries may be dangerous, and resulting cosmetic defect and alopecia lead to social stigma and poor self-esteem. Early intervention in the form of microvascular repair and replantation prevent morbidity and improve outcome. In this case series, we have discussed 3 cases of scalp replantation, 2 complete and 1 partial. Immediate microvascular reconstruction was planned in each case. Single surgical team approach was followed, vessels were identified and operated under an operative microscope. No vein grafts were used. Operative outcome was good, and scalp healed well. Cosmetic outcome was excellent, and there was no need for secondary revisions or use of tissue expanders. Immediate referral of such cases to institutes with facility for microvascular repair is recommended to reduce ischemia time. Superficial temporal artery is the first choice for microvascular repair in scalp replants, and a single artery anastomosis is sufficient to perfuse the entire scalp. Deep temporal artery is a viable alternative in cases where repair with superficial temporal vessels will require use of vein graft, cutting short operative time and associated complications.