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

Abstract

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.