Long-Term Outcome of an Infant With Severe Head Burns Involving Skull and Brain Injury: A 37-Year Follow-Up

Area of Science:

• Neurosurgery
• Pediatric Burn Reconstruction
• Craniofacial Surgery

Background:

• Severe thermal head burns in infancy can lead to extensive calvarial defects and brain injury.
• Syndrome of the trephined, characterized by neurological symptoms fluctuating with atmospheric pressure, can develop secondary to large skull defects.
• Long-term outcomes of extensive craniofacial reconstruction in pediatric burn survivors are crucial to understand.

Purpose of the Study:

• To detail the 37-year follow-up of a patient with a significant calvarial defect and occipital lobe injury resulting from early-childhood thermal burns.
• To evaluate the long-term efficacy of cranioplasty in resolving neurological sequelae associated with large skull defects.
• To assess the patient's functional and social integration following reconstructive surgery.

Main Methods:

• The case report describes a patient with a 10×11 cm bone defect following 8 initial surgeries for thermal burns sustained at 4 months old.
• Cranioplasty was performed at age 17 years or younger using autologous rib grafts and a free rectus abdominis flap.
• Long-term follow-up included clinical assessment of neurological status, functional outcomes, and social integration over 37 years.

Main Results:

• The patient experienced syndrome of the trephined symptoms, including headaches, vomiting, and motor weakness, during childhood.
• Cranioplasty successfully resolved the majority of neurological symptoms.
• At 37 years old, the patient is socially integrated and employed as a caregiver, with residual mild intellectual disability and sensitivity to pressure changes.

Conclusions:

• Cranioplasty using autologous rib grafts and free flaps is an effective long-term solution for large pediatric calvarial defects.
• Reconstructive surgery can significantly improve neurological function and facilitate social reintegration in survivors of severe childhood head trauma.
• Long-term follow-up highlights the potential for good functional and social outcomes despite early-life severe injuries and reconstructive procedures.