Case Presentation:
A 10 years old girl presented to the emergency department with a
complete scalp avulsion as a result to an electric bicycle injury.
Initial observation (Figure 1) revealed that avulsed tissue extended to
nose root, bilateral supra-tarsal folds of the temporal region including
eyebrows, and the left auricle. Additionally, the frontal bone was
completely naked.
The patient on presentation was oriented and fully responsive with a
Glasgow score of 15. There were no nausea, vomiting, or convulsions. The
blood pressure was 100/50 and the heart rate was 106. She had no prior
medical problems and was not on any medications at the time of her
injury. On clinical examination: There were no fractures or bruises in
her trunk or limbs. Initial management included Intravenous fluids and
antibiotics, blood transfusion, and topical anti-septic. .
Her laboratory investigations showed low levels of blood component; red
blood cells were 1.84×10^6/ul, haemoglobin was 5.6 g/dl, HCT was
16.1%, platelets were 103×10^3/ul, and there was a slight elevation
in granulocytes 80.9%. Other laboratory tests were normal.
Soon after, we arranged a scalp reconstructive procedure in which we
harvested a full-thickness skin graft from the anterior right thigh and
was expanded by a zimmer dermatome mesher. Edges of the graft were
attached to the scalp using staplers and nylon stitches (Figure 2).
Several follow-ups revealed healthy and uncompromised graft but with
complete both hair and sensory loss (Figure 3). Finally, the patient was
able to return to her normal life and she reports no difficulty in
carrying out daily activities.