The TEMPO-Mi protocol (trepanation, stimulation, matrix, pressure, optimization, micrograft) for Sequential reconstruction of complex pediatric scalp avulsion.

Background: Extensive scalp avulsions in pediatric patients are rare and represent a significant reconstructive challenge, particularly when compounded by contamination, periosteal damage, and bone exposure-factors that limit conventional surgical options. Management focuses on achieving optimal functional and aesthetic outcomes. Case presentation: We report the case of a 6-year-old girl who sustained an extensive scalp avulsion following a severe attack by three Rottweiler dogs. A staged reconstructive approach using the TEMPO-Mi protocol was implemented, enabling progressive granulation tissue formation and subsequent definitive coverage with successful graft integration within a relatively short timeframe. Conclusion: The TEMPO-Mi protocol represents an alternative reconstructive strategy for the management of complex wounds with exposed bone and extensive soft-tissue avulsion. Its primary objective is to promote the early development of a well-vascularized recipient bed, enabling definitive functional reconstruction within a shorter timeframe than that typically required with conventional reconstructive strategies.