Avulsive scalp wounds are difficult to treat due to the loss of skin as well as the loss of hair. Not only does such a wound leave the patient with a significant cosmetic deformity, but with a loss of protection of the skull. Additionally, the lack of hair exposes the remaining skin to the damaging effects of the sun. Several factors make these injuries difficult to treat. Concomitant injuries, infections, and a patient’s medical history may play a role. From a technical point of view, avulsive scalp wounds present specific challenges. Replacing the missing scalp with hair bearing skin of a similar pattern and density to adjacent scalp is a primary goal. Additionally, reconstructed scalp must be of the same thickness as adjacent scalp. Occasionally, a scalp wound is small enough that primary closure is possible.

When primary closure is not possible, split thickness skin grafting may be required as a temporizing measure until definitive reconstruction can be carried out. Tissue expanders are an excellent option to expand the patient’s remaining scalp to allow for rotational flaps to be created to reconstruct the avulsive scalp wound.

This abstract will review reconstructive techniques to address avulsive scalp wounds and will present a case of an avulsive scalp wound which was complicated by infection, concomitant injuries, and a smoking history, but was ultimately reconstructed with the use of tissue expansion.

Conflict of interest: None declared.