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.