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The Journal of Craniofacial SurgeryTotal scalp avulsion is a rare injury that poses a unique reconstructive challenge. Microsurgical replantation is considered the first-line choice; yet anastomotic...
Total scalp avulsion is a rare injury that poses a unique reconstructive challenge. Microsurgical replantation is considered the first-line choice; yet anastomotic efforts may be strained to find suitable recipient and target vessels. Concomitant injuries may also delay or hinder operative intervention. These complex scenarios are difficult to navigate and necessitate multidisciplinary input to optimize outcomes. As such, the authors present an illustrative case report of a total scalp avulsion injury that underwent successful microsurgical replantation. This report highlights the novel use of loupe magnification in scalp replantation and reviews technical and clinical nuances that facilitate a favorable reconstruction.
Topics: Amputation, Traumatic; Anastomosis, Surgical; Eye, Artificial; Humans; Microsurgery; Scalp
PubMed: 34967529
DOI: 10.1097/SCS.0000000000007897 -
Internal Medicine (Tokyo, Japan) 2015
Topics: Aged; Anti-Inflammatory Agents; Deferoxamine; Humans; Male; Octreotide; Prednisolone; Sarcoidosis; Scalp; Tomography, Emission-Computed; Treatment Outcome
PubMed: 26521919
DOI: 10.2169/internalmedicine.54.5110 -
Radiology Oct 2022
Topics: Diagnosis, Differential; Humans; Osteoarthropathy, Primary Hypertrophic; Scalp
PubMed: 35727154
DOI: 10.1148/radiol.213027 -
BMJ Case Reports Jan 2023We present a rare case of microsurgical replantation of a total scalp avulsion. A woman in her mid-60s was renovating a tractor when her hair was caught in a column...
We present a rare case of microsurgical replantation of a total scalp avulsion. A woman in her mid-60s was renovating a tractor when her hair was caught in a column drill resulting in traumatic scalp avulsion. The avulsed scalp involved the eyebrows and the entire hair-covered part of the scalp. The prehospital management and the conservation packing of the scalp was very effective. Microsurgical replantation was achieved with anastomoses of the left superficial temporal artery and one temporal vein on each side. The combination of the prehospital treatment and our university hospital setup made it possible to reattach the scalp with an ischaemia time of approximately 5 hours. A functional and aesthetically pleasing outcome was achieved, and the patient was discharged 6 days postoperatively with a vital scalp and no complaints. Five months postoperatively, she has no sign of alopecia and is regaining sensation and function of the scalp.A woman in her mid-60s was renovating a tractor when her hair was caught in a column drill resulting in traumatic scalp avulsion. The avulsed scalp involved the eyebrows and the entire hair-covered part of the scalp. The prehospital management and the conservation packing of the scalp was very effective.
Topics: Female; Humans; Scalp; Microsurgery; Replantation; Hair; Amputation, Traumatic
PubMed: 36609423
DOI: 10.1136/bcr-2022-252570 -
Revista Da Associacao Medica Brasileira... Dec 2016Arteriovenous malformations (AVMs) of the scalp are rare lesions. The clinical picture presents with complaints of increased scalp, scalp disfigurement, pain and...
Arteriovenous malformations (AVMs) of the scalp are rare lesions. The clinical picture presents with complaints of increased scalp, scalp disfigurement, pain and neurological symptoms. Its origin can be congenital or traumatic. We present a case of giant scalp AVMs and its management, followed by a brief literature review on the subject. The diagnosis of scalp AVMs is based on physical examination and confirmed by internal and external carotid angiography or computed tomographic angiography (CTA). Surgical excision is especially effective in scalp AVMs, and is the most frequently used treatment modality.
Topics: Adult; Arteriovenous Malformations; Computed Tomography Angiography; Humans; Male; Photography; Scalp
PubMed: 28001255
DOI: 10.1590/1806-9282.62.09.828 -
Journal of Cutaneous Medicine and... 2015Chemotherapy-induced alopecia is one of the most distressing side effects of cancer treatment. Although there have been a number of investigated strategies to reduce... (Review)
Review
BACKGROUND
Chemotherapy-induced alopecia is one of the most distressing side effects of cancer treatment. Although there have been a number of investigated strategies to reduce this, there is no standard of care for treatment.
OBJECTIVE
This review aims to summarize the relevant evidence for the treatments available for chemotherapy-induced alopecia.
METHODS
A literature search using PubMed and the MEDLINE subengine was completed. The terms "chemotherapy," "alopecia," "quality of life," and "strategies" were used, and articles from the last 10 years were considered. The pediatric population was not investigated.
RESULTS
Physical therapies for alopecia prevention have shown some promise but range from insufficient to detrimental depending on the type of cancer. Cold caps may be more effective than tourniquets and may be associated with fewer metastatic events. Pharmacologic therapies, both immunomodulators and growth factors, have stood the test of several trials to date. In particular, cyclosporine has been shown either to prevent alopecia or promote hair growth during a chemotherapy regimen.
CONCLUSION
Although the evidence is not yet overwhelming, it is becoming clear that a combination of mechanical and chemical interventions may help compensate for the downfalls of either therapy alone.
Topics: Alopecia; Antineoplastic Agents; Humans; Neoplasms; Scalp
PubMed: 25775657
DOI: 10.2310/7750.2014.13200 -
Traffic Injury Prevention 2021Medical data has lead to the common understanding that bicycle helmets need to be improved to better protect against brain injuries resulting from rotational...
OBJECTIVE
Medical data has lead to the common understanding that bicycle helmets need to be improved to better protect against brain injuries resulting from rotational acceleration. Although many different technologies exist for reducing rotational acceleration during impacts, the lack of an official testing standard means that their evaluation is based on customized set-ups that may differ and not represent real accident conditions. Previously, the authors have shown that scalp tissue plays an important role during helmet testing by absorbing energy and creating a low friction interface between head and helmet, thus reducing rotational accelerations and velocities. However, no published study has yet examined the effectiveness of anti-rotational helmet technologies in the presence of a biofidelic scalp layer. The objective of this study is to address this gap.
METHODS
Three different commercially available helmet models, each one equipped with a different technology, were tested in the presence of scalp tissue, in two different scenarios; with and without the technology present. The effectiveness of each of these technologies is already documented in other studies, but only in the absence of a biofidelic scalp layer. Tests were carried out using HIII headform with porcine scalp attached to the outmost layer. Motion tracking was used to compare the impact kinematics of each helmet model in both scenarios.
RESULTS
Results showed that when a biofidelic scalp layer is present, there is no statistical difference between helmet models with and without the anti-rotational technology in terms of rotational acceleration, velocity, relative rotation, impact duration and injury risk.
CONCLUSIONS
Results suggest that the presence of the scalp can obscure the functionality of anti-rotational acceleration technologies. This could indicate that the effectiveness of technologies tested in previous studies, which have not tested anti-rotational acceleration technologies in the presence of a realistic scalp layer, may exaggerate the contribution of such technologies if compared with a more biofidelic set-up. The study supports the fact that headforms should be better designed by incorporating artificial skin layers that can better imitate scalp's behavior and, in addition, provides insights for the design of technologies against rotational acceleration.
Topics: Acceleration; Bicycling; Brain Injuries; Head Protective Devices; Humans; Rotation; Scalp; Technology
PubMed: 33252249
DOI: 10.1080/15389588.2020.1841179 -
Developmental Dynamics : An Official... Jul 2022How developing brains mechanically interact with the surrounding embryonic scalp layers (ie, epidermal and mesenchymal) in the preosteogenic head remains unknown....
BACKGROUND
How developing brains mechanically interact with the surrounding embryonic scalp layers (ie, epidermal and mesenchymal) in the preosteogenic head remains unknown. Between embryonic day (E) 11 and E13 in mice, before ossification starts in the skull vault, the angle between the pons and the medulla decreases, raising the possibility that when the elastic scalp is directly pushed outward by the growing brain and thus stretched, it recoils inward in response, thereby confining and folding the brain.
RESULTS
Stress-release tests showed that the E11-13 scalp recoiled and that the in vivo prestretch prerequisite for this recoil was physically dependent on the brain (pressurization at 77-93 Pa) and on actomyosin and elastin within the scalp. In scalp-removed heads, brainstem folding was reduced, and the spreading of ink from the lateral ventricle to the spinal cord that occurred in scalp-intact embryos (with >5 μL injection) was lost, suggesting roles of the embryonic scalp in brain morphogenesis and cerebrospinal fluid homeostasis. Under nonstretched conditions, scalp cell proliferation declined, while the restretching of the shrunken scalp rescued scalp cell proliferation.
CONCLUSIONS
In the embryonic mouse head before ossification, a stretcher-compressor relationship elastically develops between the brain and the scalp, underlying their mechanically interdependent development.
Topics: Animals; Brain; Mice; Scalp; Skull; Spinal Cord; Stretchers
PubMed: 34997665
DOI: 10.1002/dvdy.451 -
World Neurosurgery Jun 2016Scalp arteriovenous malformations (sAVMs) are well-described congenital abnormalities for which co-occurrence with other vascular pathologies significantly alters... (Review)
Review
BACKGROUND
Scalp arteriovenous malformations (sAVMs) are well-described congenital abnormalities for which co-occurrence with other vascular pathologies significantly alters management strategies. The authors describe a case in which congenital sAVM was found with concomitant intracranial, flow-dependent vascular malformation and schizencephalic developmental anomaly.
CASE DESCRIPTION
A 21-year-old man presented with a right-sided bruit and an enlarging palpable, pulsatile scalp mass. Magnetic resonance imaging demonstrated a 5-cm right sAVM and an azygos anterior cerebral artery (ACA) feeding a 2-cm parafalcine vascular anomaly, as well as an unruptured 3-mm, flow-related, distal ACA aneurysm. sAVM feeders were catheterized and embolized with Onyx 18. During resection of the right frontal scalp lesion, dissection below the pericranium was developed to expose the low-flow extracranial sAVM. A supratrochlear arterial feeder and the vascular nidus were coagulated, but radical resection was avoided to prevent scalp necrosis. An anterior right frontal parasagittal craniotomy and dural opening were performed. A developmental anomaly of the right superior frontal gyrus was noted, and a dense vascular network within the anterior parafalcine fold was excised and coagulated. The distal ACA aneurysm was cauterized and wrapped to preserve the parent artery. The patient made an excellent recovery without neurologic deficits.
CONCLUSIONS
A review of the literature demonstrated a variety of endovascular and open surgical treatments with limited consensus on standard care. While sAVMs have been described in the literature, the combination of the diverse conditions seen in this case is unique.
Topics: Arteriovenous Malformations; Central Nervous System Vascular Malformations; Humans; Male; Scalp; Treatment Outcome; Young Adult
PubMed: 27018012
DOI: 10.1016/j.wneu.2016.03.047 -
The Journal of Craniofacial SurgeryThe limited laxity of the scalp and hair-bearing nature makes it difficult to optimally repair. Primary closure is limited to small defects, while healing by secondary...
The limited laxity of the scalp and hair-bearing nature makes it difficult to optimally repair. Primary closure is limited to small defects, while healing by secondary intention requires underlying periosteum. Furthermore, the use of free flaps and skin grafting can lead to unfavorable cosmetic outcomes. This report describes a patient with a large parietal scalp dermatofibrosarcoma protuberans. Multiple resections resulted in a large scalp defect with exposed calvarium. Integra was placed over the exposed calvarium after each debridement and Negative Pressure Wound Therapy (NPWT) was applied. After granulation tissue formed, 2 DermaClose continuous external tissue expansion systems were installed. Following the application and tightening of the external tissue expanders, the wound was reduced in size, facilitating primary closure of the opposing edges. This process allowed for a large area to be covered with hair-bearing scalp with good cosmetic results.
Topics: Humans; Scalp; Tissue Expansion; Plastic Surgery Procedures; Skin Transplantation; Skull
PubMed: 35968971
DOI: 10.1097/SCS.0000000000008911