Woman's Entire Scalp and Eyebrows Torn Off While Renovating Tractor

A woman's scalp and eyebrows were ripped off her head after her hair got caught in a column drill.

The accident occurred as the woman, who is in her mid-60s, was renovating a tractor, a case study published in the journal BMJ reported. Despite the severity of the physical trauma, doctors managed to successfully reattach the scalp.

The doctors who treated the woman—who are with the plastic surgery department at Odense University Hospital in Denmark—described the injury as a "total scalp avulsion." This term is used to refer to serious injuries that involve the complete detachment of the scalp from its surrounding and underlying tissues.

These kinds of injuries are "rare and potentially life-threatening" the doctors said, with most cases linked to use of industrial and agricultural machines. Such injuries can lead to severe disfigurement and serious psychological effects for the patient. Women tend to be the victims of this kind of trauma more frequently than men because it is easier for long hair to get caught in machinery.

In the case of the woman described in the BMJ study, the piece of detached skin included her eyebrows and the entire hair-covered part of the scalp. The upper half of her left ear was left hanging only from a very thin piece of skin.

After the accident, the woman managed to call for an ambulance, and when paramedics arrived, they packed the scalp "very efficiently" in a plastic bag that was then placed in another plastic bag containing cold water and ice cubes. This step was key since it made it possible for the medical team to reattach the scalp later.

As paramedics rushed the woman to a hospital, she was reportedly sitting up, alert and awake, although paramedics administered fentanyl to ease her pain. Fortunately, the bleeding had stopped by the time the ambulance arrived at Odense University Hospital's trauma center. At this point, she was in a stable condition.

Given the nature of the trauma, the medical team conducted CT scans of her brain, facial bones and spine, but they showed no sign of intracranial bleeding or fractures.

After her initial assessment, medical staff transferred the woman to a plastic surgery operating room, where she was anesthetized. Surgeons unpacked the detached scalp and prepared it for surgery, cutting the hair short and removing any visible foreign objects.

They then proceeded to reattach the scalp to the woman's head, connecting key blood vessels that had been severed—one artery and two veins.

The surgery went well and the patient's recovery was "very successful," the doctors said. She experienced no pain following the operation, and there were largely no signs of necrosis (tissue death)—apart from that on her left ear—or infection.

She was discharged from the hospital five days after the operation. Her sutures' surgical clips were removed more than a week later.

Doctors then assessed her six months after the operation, finding that her hair was growing back "nicely" with no signs of alopecia, or abnormal loss of hair—an outcome that is often seen after a total scalp avulsion.

Besides this, the woman said she was also regaining sensation in her scalp as well as partial function of the muscle that allows her to lift her eyebrows.

"She said that she was feeling progress week by week and she was very positive about the advancement," the authors wrote in the study.

In comments made five months after her surgery, the patient said she was "very satisfied" overall with the treatment she received and thankful to all the health care professionals who helped her after the accident.

"I believe that the magnitude of the trauma combined with the fact that I only experienced a minimal amount of pain made it very surreal for me," she said in the study. "I believe it was more traumatizing for the people around me and my husband would agree. He told me that it was almost impossible to comprehend that a total scalp avulsion could be relatively pain free."

She went on: "I am very delighted that I am not suffering from alopecia, which I have been told is a well-known problem after a scalp avulsion. My hair is slowly growing back which is helping me achieve the same appearance that I had prior to my accident. My hair covers the defect on my left ear completely. Furthermore, I am starting to regain sensation in my scalp. It is slowly getting better week by week. This continued progress gives me a lot of faith for the future."

The doctors said they wanted to share the woman's experience and provide information on how this kind of injury can be treated, given how rare total scalp avulsions are and the scarcity of relevant papers on the topic in the medical literature.

"Most of the larger departments of plastic and reconstructive surgery worldwide will have the necessary setup and equipment to perform the procedure. However, only a handful of surgeons will have prior experience with this kind of injury," the authors wrote.

After reviewing the existing literature, the doctors said this is likely one of the largest scalp avulsions where a replanting was successful.

Because total scalp avulsions are so rare, there is some disagreement on how to best go about treating them. But the authors of the BMJ study said this case contributes to the existing consensus that connecting only one important artery and one or key two veins is enough to ensure sufficient bloody supply for the entire scalp.

During the operation, surgeons did not do any interventions to enhance nerve regeneration. Despite this, the patient was regaining neurological function several months later.

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