Chronically exposed calvarium following electrical burns

Srivastava, J. L.; Biswas, Gourab; Narayan, Ravi Prakash; Goel, Atul

doi:10.1016/0305-4179(93)90037-9

Cited by 12 publications

(5 citation statements)

References 16 publications

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“…[8] Srivastava presented chronically exposed calvarial electrical burns to give his experience of 14 such cases, explaining the reasons for the chronic state and their subsequent clinical management. [9] Chavoin reconstructed cranial electrical burns involving scalp, bone, and dura by using homograft, free groin flap, and cranioplasty. [10] Caffee managed a case of electrical injury with the transposition of the omentum with vascular anastomosis and skin grafts.…”

Section: Discussionmentioning

confidence: 99%

Negative pressure dressing combined with a traditional approach for the treatment of skull burn

Gümüş¹

2012

Niger J Clin Pract

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Deep burns of the calvarium due to high-voltage electrical current present serious therapeutic challenges in the healing. In this study, as an alternative approach to the treatment of burned skull, negative pressure dressing is used to facilitate separation of the necrotic bones from healthy margins of the cranium, and to encourage rapid granulation tissue formation after trephination of the bone. A 36-year-old male patient, who had been seriously injured on his head with high-voltage electrical current, is presented. On the fifth day after injury, necrosis of the scalp became clearly significant, thereby necessitating extensive debridement. Under general anesthesia, necrotic scalp was removed, leaving the calvarial bone exposed, and while devitalized calvaria was left in place, exposed bone was drilled. A vacuum-assisted dressing was then applied to the wound and set to 125 mmHg continuous pressure. Some granulation tissue developed in the holes and margins of the wound, but it was not sufficient to allow successful closure of the wound with skin grafting. Therefore, the patient underwent another operation in which devitalized outer table of the skull was easily removed from viable bone by using a little force. Elevation of the necrotic outer bony layer revealed profuse granulation tissue formation over the inner layer. When dealing with this experience, vacuum-assisted dressing seems to be a useful tool in acceleration of the separation of necrotic bones and stimulation of granulation tissue formation in burned calvarium.

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Section: Discussionmentioning

confidence: 99%

Negative pressure dressing combined with a traditional approach for the treatment of skull burn

Gümüş¹

2012

Niger J Clin Pract

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“…13 Delayed débridement of the sequestered bone was then performed and the granulation tissue was skin grafted. 14,15 This long course of treatment resulted in unnecessary patient morbidity and thus fell out of favor. The most commonly employed treatment strategy currently is early soft-tissue reconstruction, keeping the nonviable bone in situ and allowing it to vascularize from the overlying soft-tissue and underlying dura.…”

Section: Discussionmentioning

confidence: 99%

“An Algorithm for Reconstruction of Electrical Injuries of the Scalp”

Khalid

Ahmed

Rabbani

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Electrical injuries of the scalp are a frequent occurrence in developing countries. Burns can be contact or conductive and result in extensive tissue damage. The authors present their experience with treatment of scalp and calvarial electrical injuries and propose a management algorithm. Methods: This was a retrospective cohort study comprising all patients with electrical injuries of the scalp treated at the authors’ center between January of 2010 and December of 2016. Noncontrast computed tomography scans were obtained to assess viability of the calvarium in patients who presented more than 2 weeks after injury. Single-stage débridement and reconstruction were performed. All nonviable soft tissue and bone was removed. Soft-tissue reconstruction was performed with skin grafts, local scalp flaps, pedicled trapezius flaps, and free flaps (anterolateral thigh, latissimus dorsi, and scapular). Cranioplasty was performed in a delayed manner with autologous bone grafts. Results: Over a 7-year period, a total of 52 patients underwent scalp reconstruction for high-voltage (44 patients) and low-voltage (eight patients) electrical injury. All patients underwent successful soft-tissue reconstruction. Osteomyelitis with draining sinuses developed in three patients; these patients underwent flap re-elevation and bone débridement, which resulted in a healed wound and stable reconstruction. Cranioplasty was performed with split calvarial grafts in two patients and split rib grafts in four patients. One patient underwent scalp tissue expansion for hair restoration. Conclusion: The authors propose an algorithm for reconstruction of electrical injuries of the scalp. Thorough débridement of the calvarium is the most important determinant of a successful outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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“…Often the injured site takes about a week for complete demarcation. 4 Therefore, thorough assessment and serial debridement are required before deciding definitive size of the scalp defect to plan for final dimension of the flap. 5 Injuries to the frontal sinus, particularly when complicated by leak of cerebrospinal fluid or obstruction of the nasofrontal outflow tract, represent special challenges.…”

Section: Discussionmentioning

confidence: 99%