Complication of full-thickness calvarial burn in an infant

Calvarial burns are rare and represent a treatment challenge with a high risk for complications. Although scalp burns may be reconstructed by methods such as skin grafting and tissue expansion, deeper burns with involvement of the underlying bone require more advanced techniques such as prosthetic or autologic cranioplasty and cutaneous coverage using soft tissue transfer. This is a report of a rare case of a 5-month-old boy who presented with severe second-, third-, and fourth-degree burns involving parts of his face, scalp, and hands (∼15% TBSA). Because of the extensive damage, debridement of the soft necrotic tissues of the scalp, a right frontal bone craniectomy, and removal of the underlying dura were performed. To reconstruct the dura, a periosteal graft was used, and a large, posteriorly based pedicled fasciocutaneous scalp flap was transposed to cover the defect of the scalp and forehead. Postoperatively, the child developed an unusual sequella of a growing skull defect, presented by a bulging frontal lobe through the bone defect, which produced a cranial deformity, signs of raised intracranial pressure, and resulting altered neurological status. To relieve the pressure, a ventriculoperitoneal shunt was inserted. Later, cranioplasty using alloplastic material (methyl methacrylate) was performed. Further reconstructive surgeries were subsequently performed to improve the child's appearance and functioning. A 5-year follow-up after the burn revealed that the patient demonstrated no gross or fine motor skill deficits or any gross behavioral impairment.