A 7-hour long emergency plastic surgery at Meenakshi Mission Hospital and Research Centre, replanted a 30-year-old woman’s scalp which was ripped off, exposing the entire skull, the forehead, and two-thirds of the left ear, in a freak accident at a manufacturing unit. The key challenge of the surgery involved identifying the damaged micro arteries and veins, as thin as hair strands, in the scalp and joining them to restore the blood supply.
The medical team had to perform the same procedure, known as microvascular anastomosis, one more time, a few hours after the marathon surgery, as the blood supply was suboptimal in a part of the replanted scalp. These timely surgical interventions literally gave a facelift to the woman from Madurai, a semi-skilled labourer from a poor household, who otherwise would have had to live the rest of her life with permanent disfigurement and mutilating injuries.
A competent surgical team, led by Dr. Binita Jena, Senior Consultant & Head of the Department of Plastic Surgery and Dr. Bhavya Manoshila, successfully replanted the avulsed scalp, even though the patient was brought to the hospital past the golden hour (6 hours). Two weeks after the surgeries, done on December 6, 2023, the patient recovered well. There were signs of hair growth. She got discharged and is now back to take up her routine life.
The scalp consists of not only skin but also many layers such as subcutaneous tissue, and an intricate network of small blood vessels. It continues into the forehead, where, in the region of the eyebrow, it gives way to the muscles of facial expression. The goal of a replantation surgery is to restore blood supply, nerve function, and overall viability to the detached body part.
In his comments, Dr. B. Kannan, Medical Administrator, said that the severity of the avulsion made it a rare case. Besides, the patient was brought to the hospital well past the golden hour, and the avulsed scalp was not properly preserved till it was handed over to the medical team. All these added challenges to the surgical team. Still, the experts did their best and gave permanent relief to the patient. Such freak accidents can be avoided at the workplace when safety guidelines are introduced, and the staff are trained to follow them sincerely.
In her comments, Dr Binita Jena, said, “The patient is from a place called Vandiyur in Madurai. She was working in a manufacturing unit that produced nuts and bolts. On the fateful day, when she was at work on the shop floor, her hair was caught in a rotating machine accidentally. The next moment, her scalp was forcibly torn off from the head. The avulsion of the scalp was so complete that it exposed her entire skull, forehead, and two thirds of her left ear. The patient was brought to the hospital only after 6 hours. We had to check whether the patient had suffered any other injuries, especially involving the neck and spine. Since there were none, we immediately performed the surgery. We could identify the severed arteries and veins using a microscope and join them to restore the blood flow.”
Dr Binita Jena added that the second surgery was required due to congestion in the replanted scalp. “The surgeries were successful. The patient recovered well, and was discharged after two weeks. There were signs of hair growth by the time. The patient requires regular follow-ups to help us monitor the progress, address any potential issues or complications, and provide necessary guidance for ongoing care.”