Related Experiment Videos
Management of acute calvarial burns in children
Marcus Spies1, Robert L McCauley, Bradley P Mudge
1Shriners Hospitals for Children-Galveston Burn Unit, Department of Surgery, University of Texas Medical Branch, Galveston 77550-2725, USA.
Insights
Calvarial burns in children, though rare, require complex surgical management. Bone debridement with skin grafting or flap coverage effectively treats these injuries, increasing hospital stay and procedures.
Area of Science:
- Pediatric Surgery
- Burn Management
- Trauma Care
Background:
- Calvarial (skullcap) burns are rare but serious complications of thermal and electrical injuries in children.
- These injuries present significant therapeutic challenges for surgical burn care teams.
Purpose of the Study:
- To evaluate management strategies for pediatric calvarial burns.
- To compare outcomes of patients with calvarial burns to those without skull injury.
Main Methods:
- Retrospective review of pediatric patients with scalp burns extending to the bone (1986-2000).
- Comparison of 27 calvarial burn patients with 30 matched controls without skull injury.
Main Results:
- Flame burns (78%) and electrical injuries (22%) were primary mechanisms.
- 29.6% of calvarial burn patients developed full-thickness bone defects.
- Bone debridement with skin grafting (23 patients) or local scalp flaps (4 patients) achieved wound coverage.
- Calvarial burns significantly increased hospital stay and operative procedures.
Conclusions:
- Acute calvarial burns can be safely managed with bone debridement and staged autografting or early flap coverage.
- Flap coverage may reduce procedures but is often limited to electrical injuries due to wound size.
- Calvarial burns lead to substantially longer hospital stays and more operative procedures compared to non-skull burns.
Background:
Although rare, head burns involving the calvarium are a serious complication of burns and electrical injury, and present therapeutic challenges to the surgical burn care team. We evaluated our experiences and compared available strategies to address this challenge.
Methods:
Records of all burned children between January 1986 and December 2000 were reviewed. Twenty-seven children (15 boys and 12 girls) with scalp burns extending at least into the outer table of bone were identified and compared with a matched group of 30 patients admitted for acute thermal burns without skull injury.
Results:
Flame burn was the injury mechanism in 78% of these patients and electrical injury was the injury mechanism in 22%. The incidence of calvarial burns in our patient population was 1.2% for thermal burns and 5.6% for electrical injuries during the study period. The age distribution was biphasic, with maximums in infancy for thermal burns and in puberty for electrical injuries. Eight of 27 patients (29.6%) developed full-thickness calvarial bone defects. In 23 patients, calvarial burn wound coverage was achieved with bone debridement and immediate or delayed placement of autograft skin. In four patients (all with electrical injury), local scalp flaps were required for closure. The length of hospital stay and overall number of acute operative procedures significantly increased for patients with calvarial burns.
Conclusion:
Acute calvarial burns are safely managed by bone debridement in combination with staged autografting or early flap coverage. Although flap coverage reduces the number of required procedures, the extensive wound size in thermal burns restricts acute flap procedures primarily to electrical injuries. Compared with patients without skull injury, length of hospital stay and the number of acute operative procedures are tremendously increased in patients with calvarial burns.