Treatment of severe scalp avulsion injury through microsurgical vascular anastomosis, subarea multi-tubenegative pressure drainage, and anchoring sutures: a case report.

Background: Severe scalp avulsion injury is a rare and surgically challenging due to extensive wounds, calvarial exposure, and associated soft tissue damage. Historically, management has evolved from skin grafting to microsurgical replantation; however, the scarcity of reported cases hinders consensus on optimal protocols. Currently, no definitive clinical guidelines exist for these complex injuries.

Methods: We retrospectively reviewed the treatment process of a patient admitted to the Second People's Hospital of Liaocheng with a severe scalp avulsion injury. Surgical management included microsurgical vascular anastomosis of bilateral superficial temporal arteries and medial canthal artery, anchoring sutures, and subarea multi-tube negative pressure drainage (- 125 mmHg, 72 h). The clinical evaluation focused on scalp viability, hair regrowth density, and sensory recovery.

Results: The replanted scalp survived completely, with only minimal Linear scarring. Hair regrowth reached 95% density by day 13 and 100% at 12 months, with 92% sensory recovery observed at 12 months. No complications (thrombosis, infection, or necrosis) occurred. The patient expressed satisfaction with the aesthetic and functional outcomes.

Conclusion: This case highlights the novel integration of microsurgical vascular repair, subarea negative pressure drainage, and anchoring sutures, which synergistically improved flap survival and reduced complications compared to traditional microsurgical replantation alone.