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Fate of free muscle transfer covering chronically infected burned skull
1Division of Plastic Surgery, University of Utah Health Sciences Center, Salt Lake City, 84132, USA.
Abstract:
This case report describes a 28-year-old male who sustained a 46,000-V cranial electrical injury that resulted in devascularization, necrosis, and secondary infection of the skull despite bone coverage with a free muscle transfer. In the face of osteomyelitis of the skull, the free muscle transfer and the brain were not compromised. A review of the literature and this case reinforce the practice of leaving the skull in place and covering it with vascularized tissue. Resection of the infected skull and later replacement with alloplastic material were curative.
Insights
A severe cranial electrical injury led to skull osteomyelitis, but the brain remained protected. Leaving infected skull in place and covering with vascularized tissue, followed by resection and alloplastic replacement, proved curative.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Infectious Diseases
Background:
- High-voltage electrical injuries can cause severe cranial damage, including devascularization and necrosis.
- Osteomyelitis of the skull presents a significant challenge in trauma management.
- The management of infected cranial bone requires careful consideration to prevent further complications.
Observation:
- A 28-year-old male experienced a 46,000-V cranial electrical injury.
- The injury resulted in devascularization, necrosis, and secondary infection of the skull.
- Despite these complications, a free muscle transfer provided coverage, and the brain remained uncompromised.
Findings:
- The case demonstrates that even with extensive skull osteomyelitis, the brain can be protected with appropriate coverage.
- A literature review supports the practice of preserving the skull and covering it with vascularized tissue.
- Surgical resection of the infected skull followed by alloplastic reconstruction was curative.
Implications:
- This case highlights the importance of preserving native bone and utilizing vascularized tissue coverage in managing cranial electrical injuries.
- The findings support a conservative approach to infected skull segments, prioritizing brain protection.
- Successful alloplastic reconstruction offers a viable solution for restoring cranial integrity after infection.