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Rare Surgery Restores Scalp

Skin, hair torn off vineyard manager in freak agricultural machinery accident

June 12. 1990 – by Larry Maatz of The Examiner Staff – San Francisco Examiner

In an extraordinarily rare and delicate operation, the scalp of a 33-year-old woman has been surgically reattached after it was torn from her head in a freak agricultural accident. Doctors say the woman, now recovering at San Francisco’s Davies Medical Center, is expected to show little if any outward evidence of her ordeal.

The 14-hour operation, a complete scalp and forehead replantation, has been performed only six times before, say hospital officials. The patient, a Northern California vineyard manager, was not identified.

“It was close to the wire” said Dr. Alfonso Oliva, who headed the team of five surgeons at the operating table. “The scalp had been completely torn off, from the eyelids to the nape of the neck.

“But we were able start blood flowing through the scalp within 12 hours of the accident. That’s close, but close enough to be successful.”

The woman’s hair had caught in the rotor of a sprayer crankshaft during routine vineyard operations on the morning of June 4.

Co-workers preserved the scalp, and the woman was rushed by ambulance first to a local hospital, then to Davies Medical Center.

Using microsurgical techniques, Oliva and his team reattached two of the major arteries to the scalp, ensuring an adequate blood supply. Then, three veins in the exposed skull were rejoined using vein grafts from the woman’s feet.

All in all, Oliva said, eight blood vessels ranging in size from 0.5 to 1.5 millimeters in diameter, “as small as the width of lead in a mechanical pencil,” were reattached, sewn together under high-powered microscopes.

But despite the extent and gruesome severity of the injury, the woman will emerge with little or no evidence of the accident. By luck, Oliva said, the location of the separations will allow most of the scars to be covered by natural skin folds and hair.

“The actual suture line is just above the eyelids, right where you would cut for a routine eye lift,” Oliva said. “The scars at the nape of the neck and above the ears will be covered by her hair.”

That leaves only a small scar across the bridge of the nose and a scar across each temple, he said, all of which can be readily dealt with by cosmetic surgery.

“I saw photographs of her taken before the accident,” Oliva said. “She was an attractive woman then; she will be an attractive woman when it’s over.”

The woman’s spirits are good, he said.

To maintain circulation in the reattached and grafted blood vessels, the woman must rest in an upright position; she cannot recline her head even against pillows.

“Two days after the surgery.” Oliva said, “she was sitting there joking about sleeping in a ‘Buddha position.’ This woman is going to do just fine.”


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