Secondary expansion of a replanted scalp salvaged by an intrinsic arteriovenous shunt.

1. Although scalping injuries reported in most large series rarely involve young children, partial scalp replantation, even in a 2-year-old boy after a dog-bite avulsion, should also be warranted. However, technical difficulties because of the diminutive vasculature can be expected. 2. Unconventional methods for reestablishing inflow or outflow for the replanted scalp may become the only practical alternative and must not be overlooked. In this case, an arteriovenous shunt between the frontal branch of the superficial temporal artery within the amputated part itself to a more distal scalp vein at the superior edge of the fragment allowed high-output flow to maintain patency after recurrent thromboses of the conventional superficial temporal arterial anastomosis. This fistula was assumed to be the major contributor to nutrient flow of the remaining scalp, as the parietal branch was truncated along the margin of the avulsion. 3. Delayed tissue expansion is also an option. In this case, delayed expansion of the replanted scalp that survived allowed elimination of the skin grafts needed to cover areas where necrosis ensued, restoration of the anterior hairline, and resulted in a more normal appearance.