An algorithmic approach to reconstruction of complex scalp defects in electric burns

Abstract

Introduction: Reconstruction of scalp defects due to electrical burns poses a challenge to the reconstructive surgeon and a lot of controversy exists in decision making with regards to the timing of surgery, debridement of the underlying bone, choice of flap cover and the role of trephining. There also is a paucity of literature on this subject probably because of its rare incidence. Proper management of these cases could prevent serious complications like osteomyelitis of the underlying bone, epidural abscess and cosmetic disfigurement. Materials and Methods: The study was conducted at a tertiary care burn unit. A retrospective analysis was done of the patients with electrical burns involving the scalp, between 2010 and 2015. Results: In the study period there were 135 cases of electrical burns. Out of these 9 patients had electrical burns involving the scalp. Two patients with scalp defects in which the pericranium was intact after debridement were managed with skin grafts, 4 patients with moderate sized scalp defects were managed with local flaps, and in 3 patients free flaps were used to reconstruct large scalp defects. Literature search showed only two other similar case series with free flap reconstruction. We have proposed a management protocol for scalp defects in electrical burns based on our experience and a review of the available literature. Conclusion: Meticulous debridement of infected/non-viable bone is the key to a good outcome. In view of progressive tissue necrosis in electrical burns delayed reconstruction is preferred. Free flaps are the standard of care for extensive scalp defects. Local flaps and skin grafting can be used for smaller scalp defects. Secondary procedures are required for management of the alopecia and optimal cosmetic outcome.