- Email: [email protected]
Modified method of shaving an avulsed scalp before replantation
850
Correspondence and communications
Modified method of shaving an avulsed scalp before replantation In the last two decades, microsurgery has taken a great leap forward. With the refinement of microsurgical techniques, plastic surgeons can ‘put and add’ (tissue transfer), put in place what is out, and join what is separated (replantation). They have their unique place in trauma team. The success rate of microsurgery is ever increasing. Successful replantation of many tissues is possible.
Figure 3 The patient, on the operation table, along with the shaved scalp.
Figure 1 Avulsed scalp of a young lady following an industrial accident.
Figure 2 The scalp has been placed over the bottom of a three liter saline bottle to expand it to its near normal dimensions. This expanded scalp is then very easy to shave, with an assistant stabilizing it in place.
Recently multiple authors have reported successful scalp replantation. Many technical details have to be mastered before one can successfully attempt scalp replantation. Sabhapathy et al. give a good account of the preparations needed for the same.1 There has been a case report describing a simple method of shaving the avulsed scalp before replantation.2 We hereby suggest a slight modification of the described method that would make the mentioned technique easier. The support taken in the original technique was quite small for the completely avulsed scalp. We suggest the use of the bottom of a ‘three litre saline bottle’ for this purpose. The avulsed scalp is shown in Fig. 1. The scalp and the bottle are scrubbed and prepared. The scalp is fitted on the bottom of the bottle while an assistant supports it. The bottle used opens up the whole scalp and supports it for easy shaving (Fig. 2). The scalp is expanded to its near normal dimensions adding ease to shaving. It saves a significant amount of time compared with our struggles to achieve the same on previous occasions. Figure 3 shows a completely shaved scalp and the patient just before the replantation. We also would like to inform the readers that it is better not to cut short the hairs prior to shaving. This would unnecessarily contaminate the inner (raw) surface of the scalp with bits of fine hairs; the removal of them would be a difficult and lengthy process. Secondly, gentleness is needed during handling as the collaterals should not get contused, which is the basis of survival on single anastomosis. We also would like to use this opportunity to inform the readers that it is very important to maintain an upright position of the head in the immediate postoperative period. Failure to observe this could lead to ischaemia in the dependent part (due to the weight of the head), as happened in our case. The dependent occipital part was lost in our patient and needed skin grafting (Fig. 4A). The rest of the scalp survived well, except for a small area of de-epithelialisation over the parietal area (Fig. 4BeD).
Correspondence and communications
851
Figure 4 Postoperative photographs: A) the posterior view; skin loss over the occipital area which has been covered with split skin graft B) Lateral view scalp survived, while the avulsed part of ear didn’t . C) oblique view; forehead survived completely D) view from above; the partial thickness loss of skin. The deep elements are intact as can be appreciated from the hair growth.
References 1. Sabapathy S, Venkatramani H, Bharathi R, et al. Technical considerations in replantation of total scalp avulsions. J Plast Reconst Aesthet Surg 2006;59:2e10. 2. Venkatramani Hari, Raja Sabapathy S. Simple method of shaving avulsed scalp before replantation. Plast Reconstr Surg 2001;107:286.
K.G. Bhaskara Rahul Patil Philip Vinoth Medical Trust Hospital, Cochin, Kerala, India E-mail address: [email protected] ª 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2007.10.067
A practical dressing to the umbilical stalk Umbilicoplasty is an essential part of abdominoplasty and its postoperative distortion or complication may create
visible scars or a non-aesthetic shape of this important anatomical structure. There are many operative techniques to reconstruct the umbilicus during abdominoplasty and the goal of these techniques is to obtain a natural appearance of the structure. Despite technical improvement, umbilical stenosis is still a frequent postoperative complication, mainly due to scar contracture promoted by excessive tension of the skin suture. Some authors have described tactics to minimise or avoid this complication, such as different types of cutaneous incisions and tension-less skin suture. Nevertheless it is important to consider that the healing process may cause unexpected surprises. Therefore, the umbilical constriction can be prevented not only by technical care but also with the use of an adequate umbilical dressing in the immediate postoperative period. Considering these observations, we aim to present a simple but effective dressing for the umbilical stalk by the use of a vaginal tampon (Fig. 1). Abdominoplasty is, then, performed and after the anterior rectus plication we perform the measurement of the umbilical pedicle. If the height of the umbilical pedicle is around 75% of the distance between the fascia and the abdominal skin, we do not consider umbilical fixation because it could promote excessive tension at the edges of the skin to be sutured at the
Correspondence and communications
Modified method of shaving an avulsed scalp before replantation In the last two decades, microsurgery has taken a great leap forward. With the refinement of microsurgical techniques, plastic surgeons can ‘put and add’ (tissue transfer), put in place what is out, and join what is separated (replantation). They have their unique place in trauma team. The success rate of microsurgery is ever increasing. Successful replantation of many tissues is possible.
Figure 3 The patient, on the operation table, along with the shaved scalp.
Figure 1 Avulsed scalp of a young lady following an industrial accident.
Figure 2 The scalp has been placed over the bottom of a three liter saline bottle to expand it to its near normal dimensions. This expanded scalp is then very easy to shave, with an assistant stabilizing it in place.
Recently multiple authors have reported successful scalp replantation. Many technical details have to be mastered before one can successfully attempt scalp replantation. Sabhapathy et al. give a good account of the preparations needed for the same.1 There has been a case report describing a simple method of shaving the avulsed scalp before replantation.2 We hereby suggest a slight modification of the described method that would make the mentioned technique easier. The support taken in the original technique was quite small for the completely avulsed scalp. We suggest the use of the bottom of a ‘three litre saline bottle’ for this purpose. The avulsed scalp is shown in Fig. 1. The scalp and the bottle are scrubbed and prepared. The scalp is fitted on the bottom of the bottle while an assistant supports it. The bottle used opens up the whole scalp and supports it for easy shaving (Fig. 2). The scalp is expanded to its near normal dimensions adding ease to shaving. It saves a significant amount of time compared with our struggles to achieve the same on previous occasions. Figure 3 shows a completely shaved scalp and the patient just before the replantation. We also would like to inform the readers that it is better not to cut short the hairs prior to shaving. This would unnecessarily contaminate the inner (raw) surface of the scalp with bits of fine hairs; the removal of them would be a difficult and lengthy process. Secondly, gentleness is needed during handling as the collaterals should not get contused, which is the basis of survival on single anastomosis. We also would like to use this opportunity to inform the readers that it is very important to maintain an upright position of the head in the immediate postoperative period. Failure to observe this could lead to ischaemia in the dependent part (due to the weight of the head), as happened in our case. The dependent occipital part was lost in our patient and needed skin grafting (Fig. 4A). The rest of the scalp survived well, except for a small area of de-epithelialisation over the parietal area (Fig. 4BeD).
Correspondence and communications
851
Figure 4 Postoperative photographs: A) the posterior view; skin loss over the occipital area which has been covered with split skin graft B) Lateral view scalp survived, while the avulsed part of ear didn’t . C) oblique view; forehead survived completely D) view from above; the partial thickness loss of skin. The deep elements are intact as can be appreciated from the hair growth.
References 1. Sabapathy S, Venkatramani H, Bharathi R, et al. Technical considerations in replantation of total scalp avulsions. J Plast Reconst Aesthet Surg 2006;59:2e10. 2. Venkatramani Hari, Raja Sabapathy S. Simple method of shaving avulsed scalp before replantation. Plast Reconstr Surg 2001;107:286.
K.G. Bhaskara Rahul Patil Philip Vinoth Medical Trust Hospital, Cochin, Kerala, India E-mail address: [email protected] ª 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2007.10.067
A practical dressing to the umbilical stalk Umbilicoplasty is an essential part of abdominoplasty and its postoperative distortion or complication may create
visible scars or a non-aesthetic shape of this important anatomical structure. There are many operative techniques to reconstruct the umbilicus during abdominoplasty and the goal of these techniques is to obtain a natural appearance of the structure. Despite technical improvement, umbilical stenosis is still a frequent postoperative complication, mainly due to scar contracture promoted by excessive tension of the skin suture. Some authors have described tactics to minimise or avoid this complication, such as different types of cutaneous incisions and tension-less skin suture. Nevertheless it is important to consider that the healing process may cause unexpected surprises. Therefore, the umbilical constriction can be prevented not only by technical care but also with the use of an adequate umbilical dressing in the immediate postoperative period. Considering these observations, we aim to present a simple but effective dressing for the umbilical stalk by the use of a vaginal tampon (Fig. 1). Abdominoplasty is, then, performed and after the anterior rectus plication we perform the measurement of the umbilical pedicle. If the height of the umbilical pedicle is around 75% of the distance between the fascia and the abdominal skin, we do not consider umbilical fixation because it could promote excessive tension at the edges of the skin to be sutured at the