Scalp Avulsion Combined with Unusual Severe Open Craniocerebral Avulsion Injury

2839 Correspondence To the Editor: Scalp avulsion is a severe type of scalp injury, which is most often caused when long, braided hair is caught in running wheels. However, scalp avulsion combined with an open skull avulsion fracture is extremely rare. Here we report a unique case of scalp avulsion combined with open craniocerebral injury. A 19‑year‑old female was transferred to our emergency department. Twelve hours prior to admission, the patient's hair was caught in a machine that was rotating at a high speed, resulting in a severe scalp avulsion. Glasgow Coma Scale score was 9 points. This bilateral, peeled avulsion included over 90% of the frontal, temporal, parietal and occipital scalp, and the scalp was avulsed into two flaps. There was a comminuted fracture of the right frontotemporal skull. The fractured bony fragments protruded outward and were deformed, the dura was torn, and blood clots and necrotic brain tissue were leaking from the rupture [Figure 1]. A computed tomography scan demonstrated a cerebral contusion in the right frontotemporal lobe, an intracerebral hematoma, and a comminuted fracture of the right frontotemporal skull [Figure 1]. Neurosurgeons and plastic surgeons jointly performed emergency surgery. Debridement and hemostasis were performed. Because such a large area of the scalp was avulsed and was accompanied by severe crush injuries, vascular anastomosis could not be performed due to the poor vascular condition. Therefore, a reverse‑drum skin collection and replantation, combined with an in situ flap suture, was done. The skin graft on the right frontal, temporal, parietal, and occipital scalp had also survived well. The flap in situ suture of the left frontotemporal was necrosis. After the surgery, the patient suffered from intracranial infection. On postoperative day 16, central respiratory and heart failure occurred and the patient died of severely intracranial infection. In the present case, the patient was a female with long thick hair. During the course of work, her hair was caught in a machine that was rotating at a high speed. The resulted large amount of traction led to a large area of scalp avulsion. The injury also involved right frontal bone, dura, and brain tissue. Scalp avulsion combined with open craniocerebral injury was even much rarer than scalp avulsion alone. Hence, we believe that the mechanism and characters of this fracture are worthy to be carefully discussed. Skull fractures are generally categorized into linear fracture, depressed fracture, comminuted fracture, and growing skull …