According to Zhang Hongbin, director of the Department of Pediatric Surgery of the First Affiliated Hospital of Kunming Medical University on March 25, a team of experts from the Department of Pediatric Surgery, Burn Plastic and Maxillofacial Surgery, the Department of Neurosurgery, the Department of Anesthesiology, and the Children's Intensive Care Unit successfully rescued a 5-year-old girl from Qujing City, Yunnan Province. It is reported that such a large area and long out-of-vitro scalp complete avulsion injury is rare in pediatric surgery, and the scalp of the child is isolated from the body for a long time, and the lack of vascular anastomosis conditions after neurosurgical evaluation makes it difficult to treat. Finally, with the intervention of experienced plastic surgeons, scalp grafting is performed to achieve the best cosmetic repair results.
Zhang Hongbin, director of the Department of Pediatric Surgery of the First Affiliated Hospital of Kunming Medical University, said that as of March 25, Yang Lili's vital signs were stable, various physiological indicators were normal, and the scalp was alive and in good shape.
Yang Lili's mother said: On March 9, 5-year-old Yang Lili accidentally fell down while playing with her mother at work, unfortunately her hair rolled into the bench drill next to her, and the huge traction generated by the high-speed bench drill instantly completely avulsed off a large piece of scalp on the top of Lili's head. Immediately sent to the local hospital, due to the serious injury of Lili, the local hospital has no corresponding treatment experience, the doctor to Lili's wound to stop the bleeding and guide the family to properly preserve the scalp of the body, it is recommended that the family take Lili to Kunming as soon as possible to the hospital with better medical conditions and technical level for treatment.
Zhang Hongbin introduced that after nearly 2 hours, he was sent to the Department of Pediatric Surgery of the First Affiliated Hospital of Kunming Medical University after traveling to many hospitals. At this point, the scalp has been out of the body for nearly 5 hours. Huang Jiami, the doctor on duty in the pediatric surgeon, carefully opened the gauze on the top of Lili's head layer by layer for examination, and found that the wound was more than half of Lili's scalp area, and part of the deep wound of the skull was exposed.
Director Zhang Hongbin immediately guided the treatment and applied to the hospital to urgently start the multidisciplinary consultation in the hospital. Zhang Hongbin, Director of the Department of Pediatric Surgery, Tang Zhiwei, Director of the First Department of Neurosurgery, Tang Xu, Director of the Department of Burn and Plastic Surgery, Dr. Pu Shijie of the Department of Anesthesiology, and five expert teams from the Pediatric Intensive Care Unit were quickly assembled to discuss Lili's situation. In order to gain time, the pediatric medical team methodically carried out anti-shock treatment and preoperative preparation for Lili, and the anesthesia and surgical nursing team also prepared for emergency surgery.
Tang Zhiwei, director of the Department of Neurosurgery, explored under the microscope whether the blood vessels of the isolated scalp had the conditions for anastomosis. However, intraoperative exploration found that due to the long time of separation from the body, the blood vessels have lost their anastomosis conditions, and a large number of fine hairs are embedded in the scalp, which is extremely polluted and cannot be anastomosis. However, the patient's wound is large and must be covered as soon as possible, otherwise the wound that loses the skin barrier is prone to serious life-threatening infection.
Professor Tang Xu, who has rich experience in wound reconstruction, was invited to reassess the condition of the child, and after checking the child's condition, he said that he needed urgent joint surgery. Professor Tang said that time is life for children, although there is no chance of vascular anastomosis, children's scalp is thinner, even if the scalp is replanted, there is still a chance of survival. Professor Tang introduced the key points of the operation: firstly, it is necessary to carefully wash the isolated scalp to ensure that the broken hair and other dirt on the scalp are washed, and the wound on the top of Yang Lili's head needs to be carefully cleaned and strictly hemostasis; The jagged isolated scalp should be aligned to the wound on the top of Lili's head as neatly as possible, and at the same time, the postoperative skin graft should be immobilized to prevent Lili's agitation from causing the replanted scalp to shift; finally, the postoperative dressing change is very critical, and the wound needs to be carefully evaluated and closely monitored.
After nearly 5 hours of surgery, Lili was transferred to the PICU after the scalp was successfully replanted, and she was closely monitored and treated. In the PICU, Lili received adequate sedation and aggressive anti-infection treatment, which created good conditions for the survival of the replanted scalp.
On the 12th day after the operation, Professor Tang instructed the dressing change again, and the sutures on the edge of the purse were cut and removed one by one, the sutures healed well, the scalp did not have ischemia and necrosis, the replanted scalp survived, and the replanted scalp was attached to the skull.
Professor Tang Xu, Director of the Department of Burn Plastic and Maxillofacial Surgery of the First Affiliated Hospital of Kunming Medical University, said that the success of the operation minimized the damage and repaired the wound to the greatest extent. She further said that there is no avascular necrosis of the scalp, and the replanted scalp survives, which provides a good foundation for hair growth, but after trauma, the child may have telogen effluvium 1-3 months after surgery, and can continue to be treated in the Burn Plastic and Maxillofacial Surgery Hair Loss Clinic to assist new hair growth. Although the surgery is well reconstructed, the postoperative scar needs to mature in 3-6 months, and the scar prevention clinic can continue to be treated to achieve the best cosmetic results. At the same time, the area around the scar can be covered by the little girl's long flowing hair through new hair growth and hair implantation, without affecting her wonderful life and beautiful image. Orthopedic interventional and combined surgeries can save lives while helping patients to rebuild their appearance and function to the greatest extent, and to repair psychological trauma to the greatest extent while repairing physical trauma. The child experienced a traumatic event, and at the same time, a psychiatrist needs to intervene to help the child continue to grow physically and mentally.