Background: Scalp avulsions are relatively rare injuries but plastic and reconstructive surgeons are commonly called on to either acutely manage or assist with reconstructive management of these injuries. The types of injuries can range from a simple avulsion with an adequate blood supply to a complete avulsion necessitating a microvascular reconstruction or free tissue transfer for coverage. The type of reconstructive options for such an injury depends not only upon the type, size, and location of injury but also the available blood supply to the involved tissue.

Methods: The scalp avulsion data for this project was collected retrospectively at a major level I tertiary trauma center. The patient databases were queried using ICD-9 codes for both major scalp soft tissue injuries and scalp avulsion injuries. Charts were then evaluated to assure the diagnosis of either a major scalp soft tissue injury or a scalp avulsion. Data was collected to evaluate concomitant injuries, co-morbidities, emergency department and in-hospital resuscitation, definitive treatment, length of stay, outcomes, and complications. The patients were separated into different subsets dependant upon the type of injury and blood supply to the avulsed tissue. The injuries were classified as either Type I-A - Complex laceration, Type I-B - Scalp avulsion with a good blood supply and no tissue deficit, Type II - Scalp avulsion with a poor blood supply and/or a moderate tissue deficit, Type III - Complete avulsion of tissue and/or a large tissue deficit.

Results: A total of 76 patients were reviewed over an eight year period (1999-2006). 73.4% (n = 56) of the injured patients were males with a mean injury age of 43.3 years. The average age of injury for females was 31.5 years old. 53% (n = 38) of the injuries were related to motor vehicle crashes while the second most common cause was related to physical assaults, 34.6% (n = 26). The frontal region was involved in 40.4% (n = 29) of the injuries. Alcohol was a factor in over 30% of the patients (n = 23). Additional soft tissue injuries were noted 46.9% (n = 34) of the time and associated C-spine injuries were seen in 8.1% (n = 6) of the patients. Patients with Type I-A (n = 23) had an average laceration size of 6.7cm and were treated in the emergency department 100% of the time. Type I-B patients (n = 46) had an average avulsion area of 95.4 cm2 and were treated in the emergency department 80% of the time. Patients with Type II (n = 6) and Type III (n = 1) had more complex injuries with a tissue deficit or complete avulsion and were all treated either emergently or in a delayed fashion dependant upon their concomitant injuries. The overall complication rate was low at 3.9% (n =3) for all scalp injury types.

Conclusions: The injuries were able to be separated into the different avulsion types using a retrospective review of the charts. The vast majority of time, complex scalp injuries can be managed in the emergency department. More complex injuries with tissue deficits are less common and should be treated with either acute or delayed coverage dependant upon the severity of additional injuries. The overall complication rate was low for all scalp injury types.