Successful replantation of total scalp amputation due to dog bites in geriatric patient with prolonged tissue ischemia and comorbidities: a case report

Traumatic scalp amputation is a rare and life-threatening case causing massive blood loss and serious tissue damage. This report aims to record a successful scalp replantation on a 69-year-old woman with total scalp amputation due to dog bites. The challenges of this case were age, prolonged tissue ischemia and several comorbidities such as high glucose index (uncontrolled diabetes mellitus), hypertension and obesity. After 2 hours of admission, 9 hours of stabilization and 7 hours of revascularization, left superficial temporal artery and vein end-to-end anastomosis was successful, adding to 18 hours total of warm tissue ischemia time. The patient was discharged on Day 8 without signs of reperfusion injury or infection. Elderly patients with comorbidities and long-term tissue ischemia may be at risk for reperfusion injury and infection. However, sufficient vascular anastomosis, good tissue quality and optimal evaluation can achieve a good result.