case_images: PMC6900851_01
case_images: A preoperative photograph revealed total hairy scalp and forehead avulsion with only a connection in the nuchal area
case_images: 41038_2019_171_Fig1_HTML.jpg
case_images: PMC6900851_01_41038_2019_171_Fig1_HTML.jpg
case_images: Fig1
case_images: On physical examination, the avulsed scalp involved almost the entire hairy scalp and forehead, sparing the occipital region in the nuchal area (Fig. 1).
case_images: Schematic diagram of the microsurgical anastomosis of vascular stumps with vein grafts. (Bold arrow) The right temporal artery and vein; (arrow) the left supratrochlear vein; (dashed arrow) the left supraorbital artery
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case_images: PMC6900851_01_41038_2019_171_Fig2_HTML.jpg
case_images: Fig2
case_images: End-to-end anastomosis was performed between vessels in the recipient area and counterparts area with vein grafts from the forearm (Fig. 2).
case_images: Intraoperative images after scalp replantation. After microsurgical anastomosis, a the left and b the right scalp tissue showed well perfusion according to clinical assessment. (White arrow) Please note the patency of the supraorbital artery and supratrochlear vein after anastomosis
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case_images: PMC6900851_01_41038_2019_171_Fig3_HTML.jpg
case_images: Fig3
case_images: The entire scalp appeared well perfused, was flush red in color, and had positive pinprick bleeding and restored capillary refill (Fig. 3a, b).
case_images: The intraoperative and postoperative indocyanine green angiography (ICGA) mapping results. a Intraoperative ICGA mapping with SPY-Q analysis of perfusion in the replanted scalp. Asterisk represents the left temporal area that is automatically selected as a reference with a 100% perfusion value. Areas with 25% perfusion relative to the maximal perfusion reference were traced with blue lines. Areas confined by the blue lines represent well-perfused tissue with more than 25% of the reference area perfusion. b The color reversal version of ICGA image when the necrotic area became mature. Please note the hypoperfused frontoparietal area represented by the color white
case_images: 41038_2019_171_Fig4_HTML.jpg
case_images: PMC6900851_01_41038_2019_171_Fig4_HTML.jpg
case_images: Fig4
case_images: Unexpectedly, ICGA mapping showed hypoperfusion in multiple areas that adequately perfused by the clinical assessment (Fig. 4a). Tissue perfusion was assessed again with ICGA mapping, which showed a wide range of hypoperfused frontoparietal areas with a pattern in accordance with the intraoperative ICGA mapping results (Fig. 4b). SPY-Q analysis (Fig. 4a and Fig. 5). Split skin grafting was performed with grafts from the back.
case_images: All skin grafts survived with acceptable cosmetic results at the 1-month follow-up
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case_images: PMC6900851_01_41038_2019_171_Fig6_HTML.jpg
case_images: Fig6
case_images: Acceptable cosmetic results were achieved at the 1-month follow-up (Fig. 6).