Composite scalp replacement and negative pressure therapy for successful graft take and hair regrowth

Microvascular scalp replantation is the procedure of choice after devastating scalp avulsion injuries. When replantation is not possible, alternative procedures should be considered to provide 1) wound closure and, possibly, 2) acceptable cosmetic results. A number of elective procedures including local and microsurgical flaps have historically been described. None of those procedures allow for obtaining superior cosmetic results in one single stage, as tissues being replaced are not "like with like". The use of spare parts from the avulsed scalp as a non vascularized composite hair bearing graft is reported herein, in association to negative pressure therapy. Despite very low success rate of composite scalp grafts reported into the literature, our patient had a 100% graft take and a favourable cosmetic result in terms of hair re-growth. At 6 months follow-up the graft is stable, pliable, and covered by a considerable amount of hair. The patient is very satisfied with the result. We think negative pressure device as the key factor in enhancing non-vascularized composite tissue survival including follicles. This is to our knowledge the first case of successful non-vascularized scalp replacement associated to negative pressure therapy. We think this approach should be considered when microsurgical replantation is not possible, still being available the use of spare parts, before attempting further elective procedures.