A 77-year-old woman presented with a trauma to the scalp caused from the blade of a windmill. The condition was persistent from the past 50 years. At the initial examination, a deep, foul-smelling and well-circumscribed ulcer was apparent on the head region, involving the majority of the cranium. Skin biopsy specimens of the lesion were nonspecific. The bone biopsy showed extensive necrotic areas of bone and soft tissues, with lymphocytic exudate foci. A computed tomography scan of the head revealed bone destruction principally involving both the parietal bones, and parts of the frontal and occipital bones. Streptococcus parasanguis was isolated from the skin culture, and Proteus mirabilis and Peptostreptococcus sp. were identified in the cultures from the bone. A long-term treatment with amoxicillin-clavulanic acid (1 g/12 h) and levofloxacin (500 mg/day) was prescribed, but even after 6 months, the lesion remained unchanged. The frequency of occurrence of scalp ulcers in dermatological patients is less, principally because of the rich blood supply to this area. We have not found any similar case report of a scalp ulcer secondary to chronic osteomyelitis discovered more than 50 years after the causal trauma. We want to highlight the importance of complete cutaneous evaluation including skin and bone biopsies, when scalp osteomyelitis is suspected.

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Mit der Messung des operativen Blutverlustes beschäftigten sich erstmals Gatch und Little (14). Seitdem erschienen mehrere Arbeiten über die Bestimmung des Blutverlustes während chirurgischer Eingriffe. Vor allem zeigte sich, daß der Blutverlust meist zu niedrig geschätzt und dadurch auch ungenügend ersetzt wird. Mit dem mangelhaften Füllungszustand des Kreislaufs kommt es dann zu einem Pulsanstieg und später zum Blutdruckabfall. Mancher schwere Schockzustand wäre durch eine rasche, der Größe des Blutverlustes entsprechenden Bluttransfusion oder Infusion von Blutersatzmitteln vermeidbar.

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