Clinical decision model for the reconstruction of 175 cases of scalp avulsion/defect.
PURPOSE
It has been reported widely on various methods of repairing scalp avulsion/defect, including anastomotic vessels for total scalp avulsion and dermal grafts (skin grafting, latissimus dorsi or anterior serratus flap, "visor flap" repair.). The long-term retrospective study, however, with large sample size remains rare; and there is no report on decision-making tree for repairing emergency scalp avulsion/defects under critical conditions.


METHODS
The decision-making model is provided for surgeons to design the scalp reconstruction based on the retrospective analysis of 175 cases of scalp avulsion/scalp defect. In this 10-year retrospective study, 175 cases of the repair of scalp avulsion and scalp defects in a single center were analyzed. The clinical decision model was generated based on representative cases.


RESULTS
For patients with scalp avulsion/defects, a comprehensive examination and evaluation on systemic injury and complication should be conducted first for saving lives and reducing trauma effects. To make more reasonable clinical decisions, it is also required to determine the location, size, depth of scalp defect the injury area of cranial periosteum, injury of blood vessel or other adjacent organs, and whether the scalp can be reused. Meanwhile, it is necessary to evaluate whether the patient can tolerate long-term anastomotic vascular surgery according to the vital signs and physical status.


CONCLUSION
The primary treatment goal is to decrease traumatic effects and save patient's life while repairing and reconstructing scalp avulsions and scalp defects. In addition, it is necessary to comprehensively consider the anatomical, functional and cosmetic characteristics of scalp, surgical equipment, team technical skillsets and patient's own pursuit to optimize a reasonable surgical solution.
['Cen|Hanghui|H|', 'Jin|Ronghua|R|', 'Yu|Meirong|M|', 'Weng|Tingting|T|']
D000714:Anastomosis, Surgical D000066491:Clinical Decision-Making D000069836:Degloving Injuries D004632:Emergency Medical Services D005260:Female D058752:Free Tissue Flaps D006801:Humans D008297:Male D008962:Models, Theoretical D054843:Negative-Pressure Wound Therapy D019651:Reconstructive Surgical Procedures D012189:Retrospective Studies D012535:Scalp D016038:Skin Transplantation D014656:Vascular Surgical Procedures
Scalp avulsion Scalp reconstruction Scalp defect Bone exposure Negative pressure treatment