The modified technique for a complex scalp and skull reconstruction due to the extreme electrical burn: a case report with review of literature

Trauma caused by a high-voltage current, can cause devastating physical injuries that presents distinctive clinical characteristics. In pathophysiology of electric burn, presence of hidden destruction of the deep tissue that is concealed by a healthy skin and fat is a typical feature. Also important is progressive character of tissue damages with major tissue loss in later time after the injury. Thus, it is extremely difficult to accurately assess extent of tissue damage during the first wound assessment. In this article, the modern, advanced treatment technique of the fourth degree, high-voltage electrical burn of the head in the 21-year-old man was presented. After the injury, the patient presented with two wounds on the scalp, one localized in the occipital region over the superior sagittal sinus and the second wound – in the right temporal region. The total head burn wound area was calculated for approximately 150 cm2. Besides described wounds, in the clinical examination as well as in CT imaging no abnormalities were observed. The burn wound treatment included multiple surgical debridement procedures with application of negative pressure wound therapy (NPWT) – Vivano® system. It has improved debridement of the wound bed as well as stimulated granulation tissue formation. Necrotic area of the occipital bone was removed with dura mater exposure. In the final surgical procedure, the skull was reconstructed with the bone graft taken from the adjacent region. For soft tissue coverage, modified „banana peel” technique was used with four large flaps creation, designed to provide the calvaria coverage with minimal skin graft placed in the occipital area. The patient was discharged 9 days after the surgery in a good health, no complications were observed in 6 months follow up period.