bubble_chart Overview

The avulsion of a large area of scalp from beneath the galea aponeurotica is called scalp avulsion, often caused by hair being caught in machinery or by tangential blows from high-speed blunt objects. Patients experience massive bleeding and frequently suffer from shock. The avulsion typically occurs between the galea aponeurotica and the periosteum, sometimes involving the entire scalp along with the frontalis muscle, temporalis muscle, or even the periosteum. This type of injury is characterized by significant blood loss and a high risk of infection. Inadequate treatment can be life-threatening or lead to skull infection and necrosis.

bubble_chart Clinical Manifestations

1. The scalp is avulsed from beneath the galea aponeurotica, sometimes with the entire scalp or even the frontalis muscle, temporalis muscle, and periosteum being torn away together, exposing the skull.
2. The bleeding is profuse, often accompanied by shock.
3. Prolonged exposure of the skull may lead to complications such as skull infection or necrosis.

bubble_chart Diagnosis

1. History of trauma such as hair being caught in machinery.
2. The scalp is avulsed from beneath the galea aponeurotica or periosteum, often involving a large area with significant bleeding, sometimes complicated by shock. In rare cases, small patches may be avulsed from the subcutaneous layer.
3. Full-thickness scalp defect with exposed skull bone, which may lead to skull infection or necrosis over time.

bubble_chart Treatment Measures

1. During first aid, use sterile dressings to bandage and stop bleeding, while preserving the avulsed scalp for potential use.
2. For cases where the avulsed scalp contusion is not severe, attempts can be made to perform scalp vascular anastomosis and scalp replantation, or to create a medium-thickness skin graft from the avulsed scalp for replantation. Small avulsed scalp sections can be treated with scalp transfer and suturing.
3. For large-scale scalp defects accompanied by skull and dura mater defects, dura mater and scalp repair is required during debridement. Alternatively, a vascularized greater omentum flap can be used to cover the wound, followed by initial-stage (first-stage) skin grafting or delayed skin grafting after granulation tissue forms.
4. For large scalp defects that are not treated promptly or result in exposed skull due to wound contamination or failed skin grafting, multiple drill holes spaced 1 cm apart and penetrating to the diploë can be made on the bone surface, or the outer table of the skull can be removed. Skin grafting can then be performed after granulation tissue forms.
5. Administer systemic antibiotics to prevent infection.
6. Provide symptomatic and supportive treatment.

Scalp avulsion injuries are often caused by factory workers, particularly female workers, getting their hair caught in machinery. To prevent such injuries, factory workers should avoid long hair, especially braids, and should tie up their hair securely, wear caps, and ensure no hair is exposed while working. If hair accidentally gets caught in machinery, immediately shut off the machine, cut the hair, retrieve the avulsed scalp, dress the wound with sterile bandages to stop bleeding, and transport the patient along with the avulsed scalp to the nearest hospital for emergency treatment. After flap transfer or avulsed scalp replantation surgery, ensure dressings are securely fixed to prevent slippage, as movement of the skin graft may impair healing. Additionally, intensify anti-infection treatment and provide careful nursing and monitoring to prevent graft necrosis. Due to the significant range of motion in the head and neck, monitor for potential concomitant cervical vertebrae fractures.

bubble_chart Cure Criteria

1. Healed: Scalp repaired, exposed skull covered with skin, wound healed.
2. Improved: Most of the head wound has healed.
3. Unhealed: Wound infection persists, skull infection or necrosis.