Total, nonreplantable scalp avulsion: utility of artificial dermis

Scalp avulsion is rare and generally occurs when long hair is caught in rotating devices. The main treatment issue is to restore lost tissue and hair follicles. Microsurgery has considerably facilitated the management of scalp avulsion, often allowing immediate coverage and normal hair growth. Reimplantation is clearly the best solution, and coverage can be a problem when reimplantation fails or is impossible. We describe the case of a 15-year-old teenage girl whose plait was caught in a go-kart engine and whose scalp was totally avulsed. The avulsed scalp was damaged by the engine, and detailed microsurgical examination showed that reimplantation was not feasible. Coverage was achieved by local epicranial plasty and by artificial dermis grafting once sufficient granulation tissue had formed. The avulsed surface was then covered with a thin skin graft. Total healing was obtained after 7 weeks. The regenerated skin is supple and stable over time and is easy to cover each day with a hairpiece. No ulceration has occurred after 2 years of follow-up.