Total Scalp Reconstruction after Traumatic Avulsion: Case Report with Microvascular Anastomosis of the Facial Artery

Complete scalp avulsion is a severe and rare traumatic injury, usually caused by high-energy occupational accidents, such as those occurring in agricultural or industrial settings. This injury presents a complex reconstructive challenge due to the extensive tissue loss and the need to restore both function and aesthetics of the cranial region. Microsurgery has become the gold standard for replantation of avulsed tissues, enabling optimal recovery when performed timely and with appropriate techniques. We present the case of a 38-year-old female patient who sustained a total scalp avulsion after an accident at an agricultural processing plant. The flap was properly preserved and underwent microsurgical replantation by performing an end-to-end anastomosis between a scalp artery and the left facial artery. Due to the impossibility of performing venous anastomosis, complementary postoperative management techniques were applied to ensure tissue viability. The patient exhibited a favorable clinical course with complete flap viability, partial regrowth of hair, and adequate aesthetic and functional integration. This case reinforces the importance of immediate care, specialized surgical management, and a multidisciplinary approach to optimize outcomes in patients with complex scalp injuries. In conclusion, microsurgery is an essential tool for reconstructing extensive traumatic scalp avulsions, achieving anatomical and functional restoration with satisfactory aesthetic results, even in circumstances where venous anastomosis is not feasible.