Reconstruction of a scalp defect with exposedbone following burn injury: our experience

Abstract

The reconstruction of large losses of substance through burns affecting the scalp in a full thickness-way is very demanding, especially when the cranial theca is exposed and has sustained heat damage.There are many surgical options: neighbouring flaps, autologous epidermal skin graft, dermal repla-cement graft with subsequent skin graft, galea flap with immediate thin epidermal skin graft. Dermalreplacement and immediate cutaneous grafts could also be indicated, but this method has rarely beenreported in specialist literature. We illustrate the case of a psychiatric patient who, in a suicide attemptby throwing his head into the flames of a fireplace gained a third-degree burn of a diameter of around13 cm, also affecting the cranial theca, and a large burn of about 20% of the total body surface area.The treatment involved, in a single procedure: the removal of the lesion, including the non-vital bonepart, the immediate implant of a dermal prothesis (Trademark: Matriderm®1 mm) and the skin graft.The eschar of the trunk and the upper limbs was removed at the same time and the wound graftedwith thin autologous skin. The patient was operated on the 5th day following the incident and dischar-ged with a healed wound after 16 days from the surgery with new cutaneous coverage of the craniumof a good thickness and quality. The option of carrying out the entire reconstructive surgery in a sin-gle intervention was very useful for reducing recovery time and therefore facilitating the rapid hea-ling of a difficult patient.