2 Management of full thickness electrical scalp burns preserving cranial bone.
Subject: Cirugia plastica (Historia)
Cirugia plastica (Investigacion cientifica)
Cirugia plastica (Analisis de casos)
Pub Date: 06/01/2009
Publication: Name: Puerto Rico Health Sciences Journal Publisher: Universidad de Puerto Rico, Recinto de Ciencias Medicas Language: Spanish Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 Universidad de Puerto Rico, Recinto de Ciencias Medicas ISSN: 0738-0658
Issue: Date: June, 2009 Source Volume: 28 Source Issue: 2
Geographic: Geographic Name: Puerto Rico
Accession Number: 201212351
Full Text: 2 Management of Full Thickness Electrical Scalp Burns Preserving Cranial Bone. Norma I. Cruz MD, Manuel F. Saavedra MD; Division of Plastic Surgery and Neurosurgery Section, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.

Introduction: Electrical burns of the scalp, although uncommon, are currently observed more frequently. Since the value of copper has increased over 700% in recent years, copper theft from electrical wiring has become rampant throughout the United States and Puerto Rico. Usually the copper wire thief receives a severe electrical burn which enters the hand that holds the high tension wire and exits at the head when the person falls back, or at the feet if shoes are not insulated. Method: During the past five years the Plastic Surgery Service of the University Hospital has managed the treatment of 10 patients who received full thickness burns of the scalp. These injuries resulted not only in soft tissue loss, but also in full thickness non-viable cranial bone at the base of the defect. All patients were males whose age averaged 29 years. The patients were treated initially by debridement until the wound presented viable clean soft tissue margins. Reconstructive surgery was performed at an average of 22 [+ or -] 6 days after the burn occurred. With the assistance of a neurosurgeon, multiple burr holes, following a grid pattern, were made in the non-viable cranial bone (Figure 1). This bone grid was immediately covered with a well-vascularized scalp flap. The patient's progress was documented during the hospital stay and long-term follow-up at the Plastic Surgery Clinic was provided for at least one year. Results: The multiple burr holes filled with well vascularized fibrous tissue and the contour of the skull was maintained in all 10 patients without the need of a secondary cranioplasty. No postoperative infection, osteomyelitis, or cranial bone sequestration occurred in this group of patients. Two minor wound separations due to tension at the suture line, which healed by secondary intention, were reported. The patients were satisfied with the cosmetic results and the only complaints received were associated with the lack of hair at the skin-grafted flap donor sites. Conclusion: In summary, debridement of non-viable cranial bone due to electrical burns of the scalp can be limited to multiple burr holes in a grid pattern and does not necessarily require removal of the entire section of bone. As reported by others, if the underlying bone is not infected, it can be left in situ and covered with well vascularized tissue. Even with moderately delayed management of contaminated electrical burns, partial excision of the necrotic bone with burr holes appears to be sufficient. Leaving the skull grid in situ serves as a scaffold for "creeping substitution" bone regeneration. The conservative cranial bone debridement allows the patient to maintain a normal cranial contour without the need for a secondary cranioplasty.

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