Left Forehead Research Articles

A Study on the Change of Hair Conditions Before and After Using Aroma Shampoo Bar

In this study, changes in hair condition after using aroma shampoo bars were investigated. Aroma shampoo was produced in the form of a bar (100 g) by complying with cosmetic safety standards in accordance with the Ministry of Food and Drug Safety notice. The essential oils used in aroma shampoo bars were lavender, juniper berries, cypress, peppermint, cedarwood, ylang ylang and rosemary as reference to previous studies. The subjects of this study were adults in their 20s or older, and consisted of two groups: a control group, 23 people and the experimental group, and 23 people. Aroma-free shampoo bars were used as the control group, and an aroma-containing shampoo bar was used as the experimental group. Measurement was measured once a week for 4 weeks before and after use. The hair measurement site is the top of the head, occipital region, left and right sides of the forehead. Measurement was performed with Aram Hubis’ ASG (AI-Scalp Grader). As a result of the study, there was a significant increase in hair condition changes in the density and number of the left forehead and occipital regions in the experimental group using aroma shampoos. This study has academic and social significance in that cleaning products, not products that nourish hair, can positively change hair condition and that it proved the effect of essential oils with quantitative data.

Isolated posterior capsule rupture secondary to blunt ocular trauma: Case presentation and literature review

IntroductionAn isolated posterior capsule rupture (PCR) is a rare complication associated with traumatic cataracts. We report our findings in three cases of traumatic cataracts with isolated PCR caused by blunt ocular trauma. Presentation of casesCase 1: A 1.5-year-old boy was examined after his parents noticed that the center of the pupil of the left eye was white. The mother reported that the boy had fallen and bruised his left forehead 4 months earlier. Case 2: An 18-year-old boy had a traumatic cataract that developed one month after a blow to his eye. Case 3: A 13-year-old boy was treated for hyphema and high intraocular pressure after blunt trauma to his eye. Ten days later, a total cataract developed. Anterior segment optical coherence tomography revealed an isolated PCR with a protruding lens cortex, and ultrasonography showed vitreous opacities. DiscussionAn isolated PCR was observed intraoperatively in the center of the posterior lens capsule. The lens cortex was prolapsed into the PCR or into the vitreous cavity in Case 3. An intraocular lens (IOL) was implanted in the lens capsule or to the ciliary sulcus after vitrectomy in Case 3. Vision improved in all eyes. ConclusionsOur findings indicated that the external force by a trauma to the eye can lead to an isolated PCR with a protruded lens cortex in young patients. These PCRs can be successfully treated with the IOL implanted in or out of the capsular bag.

Craniofacial Injury in a Child by Agricultural Fan Blade: A Case Report

AbstractFarm machine-related injuries in children are common modality of head injury. We describe here a case of threshing fan blade injury to head and its successful management. A 10-year-old male was brought to the emergency department of All India Institute of Medical Sciences (AIIMS) Patna with the complains of accidental fall on the fan blade of the thresher machine. On arrival he had a Glasgow Coma Scale of E1VTM5 status, bilateral pupil mid-dilated and sluggish reaction to light. On secondary survey, he had a lacerated wound of size 15 × 4 × 2 cm extending from left side forehead to right temporal region exposing bone and brain parenchyma herniation through the wound. A noncontrast computed tomography head showed B/L frontal contusion with gross edema, subarachnoid hemorrhage, and intraventricular hemorrhage. There was fracture of bilateral frontal bone extending to right parietotemporal bone. Patient was taken to operating room, where after painting and draping, the wound was irrigated with normal saline. The herniated brain was removed, securing hemostasis with surgical and Bovie cautery. He underwent a prolonged neurorehabilitation and made a complete recovery after 3 months of injury. Bihar is an eastern part of India where agriculture plays a major role in rural livelihood. Winnowing fan machines are used to separate the grain from the husk. Children have peculiar behavior to inspect things and this curious behavior leads to coming in contacts with the open blade. Falling on even a stationary blade can sometimes lead to head injury. Early surgery with meticulous wound debridement and closure of dura is required. Covering the fan blade as well as careful parenting of children will prevent further injuries.

Evaluation of cerebral autoregulation of oxygen by NIRS method during postnatal transition period in term and late preterm newborns without resuscitation requirement.

Pulse oximetry is commonly used to monitor arterial oxygen saturation and heart rate during the transition period and reference intervals have been determined. However, the effect of the change in arterial oxygen saturation on tissue oxygenation does not seem to be the same. So, a non-invasive method for monitoring cerebral or regional tissue oxygenation will be potentially useful for vulnerable infants. This study aims to evaluate the effectiveness of cerebral autoregulation in the first 10 min after delivery in term and late preterm newborns without resuscitation requirement. Cerebral tissue oxygen saturation was measured in the first 10 min after birth with near-infrared spectroscopy (NIRS) from the left forehead. Peripheral oxygen saturation was measured with pulse oximetry from the right hand and cerebral fractional tissue oxygen extraction was calculated. Nineteen late preterms and 20 term infants were included in the study. There was no statistically significant difference between median cerebral tissue oxygen saturation and cerebral fractional tissue oxygen extraction values of late preterm and term infants (p < 0.001). There was a strong inverse relationship between cerebral tissue oxygen saturation and cerebral fractional tissue oxygen extraction (p < 0.001). In late preterm infants similar to term infants, arterial oxygen saturation and cerebral tissue oxygen saturation increased with time, but inverse reduction of cerebral fractional tissue oxygen extraction showed the presence of an active autoregulation in the brain. This can be interpreted as the ability of the brain to protect itself from hypoxia by regulating oxygen uptake during normal fetal-neonatal transition process. A larger scale multi-center randomized control trial is now needed to further inform practice.

P08 Shingles in two children with no history of chicken pox

Abstract We present two cases of dermatomal, vesicular eruptions in young children. Both were otherwise well with no history of immunocompromise or prior chickenpox (varicella). Child A was 3 years old and presented with painful erythema and pustules to the left side of his nose and cheek with a sharp midline demarcation. He was admitted by the paediatricians, unwell and treated with antibiotics and acyclovir for presumed impetigo or herpes simplex virus infection. However, the swab was positive for varicella zoster virus (VZV), which in this dermatomal distribution is in keeping with shingles. Child B was an 18-month-old girl who was referred with a dermatomal vesico-pustular eruption on the left forehead, scalp and nose unresponsive to antibiotics. Despite the lack of varicella history, shingles was suspected, and the child was started on aciclovir. Swabs were positive for VZV. Shingles is rare in children and usually associated with immunocompromise. It is especially rare in those with no prior history of chicken pox and of the cases in the literature, almost all have had previous vaccination to chicken pox resulting in latent infection and subsequent shingles. We surmise that our otherwise well patients, with no prior vaccination, had previous asymptomatic chicken pox. There was a delay in the diagnosis of patient A who went on to develop trigeminal trophic syndrome with recurrent paranasal ulceration over 18 months. We highlight these cases to make clinicians aware of the possibility of shingles even in very young, immunocompetent children with no prior history of chickenpox.

Squamous Cell Carcinoma Arising in a Nevus Sebaceus in a 10-Year-Old Male

The patient is a 10-year-old male who presented to a dermatologist regarding a bleeding plaque on the right scalp. The initial pathology report demonstrated an atypical endophytic squamous proliferation with an infiltrative pattern, raising concern for squamous cell carcinoma versus pseudoepitheliomatous hyperplasia. Physical exam showed a painless 4.4 x 1.2 cm elliptical, rough, orange-to-pink plaque with waxy superficial scale on the left forehead. Wide local excision was performed, and pathology confirmed no residual carcinoma. Squamous cell carcinoma arising in a nevus sebaceous in a pediatric patient is exceedingly rare, but as demonstrated by this case, does occur, emphasizing the need for improved guidelines for management to optimize treatment in the pediatric population.

Association of intraoperative cerebral and somatic tissue oxygen saturation with postoperative acute kidney injury in adult patients undergoing multiple valve surgery

BackgroundThe association between tissue oxygenation with postoperative acute kidney injury (AKI) in adult patients undergoing multiple valve surgery has not been specifically studied.MethodsIn this prospective exploratory cohort study, 99 patients were enrolled. The left forehead, the left forearm, the left upper thigh, and the left renal region tissue oxygen saturation using near-infrared spectroscopy were monitored. The association between each threshold and AKI was assessed. The relative and absolute thresholds were < 70%, < 75%, < 80%, < 85%, < 90%, < 95%, and < 100% baseline, and baseline-standard deviation (SD), -1.5 SD, -2 SD, -2.5 SD, and -3 SD. Multivariate logistic regression analysis was adopted to explore the association.ResultsAKI occurred in 53 (54%) patients. The absolute value-based SrrO2 thresholds associated with AKI were baseline-3 SD (odds ratio [OR], 4.629; 95% confidence interval [CI], 1.238–17.314; P = 0.023) and baseline-2.5 SD (OR, 2.842; 95% CI, 1.025–7.881; P = 0.045) after adjusting for the potential confounders, those are renal region tissue oxygen saturation of 55% and 60%, but not statistically significant after correcting for multiple testing (corrected P = 0.114 and 0.179, respectively).ConclusionThe SrrO2 desaturation, defined as < baseline – 2.5 SD or < baseline – 3 SD, may be associated with AKI. The thresholds need to be verified in future large-scale studies.Trial registrationsThe study was registered at ClinicalTrials.gov, first trial registration: 26/10/2017, identifier: NCT03323203.

O04 Segmental congenital haemangioma: a novel subtype of a rare vascular tumour

Abstract Congenital haemangiomas (CH) are rare vascular tumours present at birth. These high-flow vascular lesions can lead to significant morbidity secondary to high-output cardiac failure (HOCF) and Kasabach–Merritt phenomenon (KMP). They are classically round/oval lesions and present anywhere on the body. The majority involute spontaneously in the first 2 years of life. We describe three patients who presented with an unusual segmental pattern CH of the head/scalp: the first with a segmental CH of the left forehead, extending over the left eye with associated ipsilateral heterochromia and anisocoria; the second with a segmental ulcerated CH of the right scalp – catastrophic haemorrhage from the CH sadly resulted in death at age 6 weeks; the third with a left forehead segmental CH. None of the CH in this series developed HOCF or KMP. All lesions were consistent with CH on sonography and histology where available. Patients 1 and 3 exhibited spontaneous involution in the first 2 years of life. Segmental CH have been reported once before in a series of three patients, although involving the arm/trunk rather than the head. Two of the three patients developed KMP/HOCF. The genetic basis in this cohort was identical to that of classic nonsegmental CH, activating somatic mutations in GNAQ/11. The striking segmental pattern in our cohort is likely attributable to the timing of the somatic hit during development. Identification of this pattern in CH gives important insights into vascular tumorigenesis. Further cohort studies are needed to determine if this group has differing clinical outcomes from classical CH.

Evaluation of facial temperature distribution changes during meditation using infrared thermal imaging: An experimental, cross-over study

To investigate the differences between meditation and resting states using infrared thermal imaging (IRTI) to determine facial temperature distribution features during meditation. This study also annotated the patterns of facial temperature changes during meditation from the perspective of traditional Chinese medicine facial diagnosis. Each participant performed 10 minutes meditation and 10 minutes resting but in different sequences. A concentration test was set as the task load, followed by a meditation/resting or resting/meditation session, during which the participants’ facial temperatures were observed using IRTI. Participants were scored on the Big Five Inventory (BFI) and Mindful Attention Awareness Scale (MAAS). Forehead temperatures decreased more during meditation than during the resting state. The chin temperature increased only during meditation (P < .0001). For the subjects with meditation experience, there were significant differences in the temperatures of the left forehead (P < .01), right forehead (P < .01) and chin (P < .05) between the meditation and resting state at the 10th minute. In the non-task state, the BFI-Extraversion showed a negative correlation with the temperature of the left forehead (R =﹣0.41, P = .03). In the post-task state, the temperature of the left forehead was negatively correlated with scores on the MAAS (R =﹣0.42, P = .02). Using IRTI to study meditation offers a practical solution to the challenges in meditation research. The results indicate that an increase in chin temperature may be a representative feature of a meditation state, and forehead temperature is also a potential indicator.

P20 A mysterious case of recurrent malignant melanoma

Abstract A 74-year-old White man presented to community dermatology services in 2020 with one lesion on the right temple and one on the left forehead. These were investigated with punch biopsies and reported as benign intradermal melanocytic naevi. One year later, he was referred to our teledermatology clinic with a pink nodule on the right temple, which had never healed following the 2020 biopsy. The teledermatology photos were more in keeping with basal cell carcinoma (BCC) and he was booked in for an excision. Histology reported the lesion as ulcerated invasive malignant melanoma (Breslow thickness 3.1 mm and mitotic figures). At this stage, previous biopsies from 2020 were reviewed and invasive malignant melanoma (MM) was confirmed. He was reviewed in the clinic and, on skin examination, he had a 7-mm BCC on the right upper nasal bridge. We found a small scar, but no lesions, on the left temple. He had areas of psoriasis on his elbows and knees. No organomegaly or lymphadenopathy was identified on systemic examination. He underwent wide local excision (WLE) of the right temple MM scar with sentinel lymph node biopsies from the right neck, which were negative. Initial radiological imaging did not show any metastases. Three-month follow-up computed tomography showed colon thickening, and the patient was diagnosed with hepatic flexure tumour, which was treated with right hemicolectomy. Further imaging showed no evidence of metastases. In September 2022, a new 6-mm, light-brown indentation was identified on the medial edge of the melanoma scar on the right temple. Initially, the biopsy results reported recurrent melanoma. Further histological slide review and immunochemical analysis demonstrated langerin with multinucleated histiocyte-like cell infiltrates and lymphohistiocytic inflammatory cell infiltrates; Langerhans cell histiocytosis (LCH) was diagnosed. He underwent WLE of this lesion and positron emission tomography; we are still awaiting the results. He has been referred to a specialist haematology team and is awaiting further management. LCH is a rare, multisystem haematological disorder of the clonal proliferation of Langerhans cells. Existing case reports document LCH with concomitant presentations of myeloproliferative disorders, particularly myeloid leukaemias, or noncutaneous manifestations, including pulmonary presentations. To the best of our knowledge, there have been no reports of LCH presenting exclusively with cutaneous manifestations clinically mimicking recurrent MM. The rare incidence and misleading presentation of LCH often results in its lack of consideration as a differential diagnosis for recurrent solitary skin lesions in adults. This case also highlights the diagnostic challenges and thorough investigation required for this unique condition.

Evaluation of the effects of 10% and 30% gluconolactone chemical peel on sebum, pH, and TEWL.

Gluconolactone (GLA) exhibits antioxidant and moisturizing effects. It also presents soothing effects, protects elastin fibers from UV-induced degradation, and improves the function of the skin barrier. Evaluation of skin parameters such as pH, transepidermal water loss (TEWL), sebum levels before, during, and after a series of applications of 10% and 30% GLA chemical peel in a split-face model. The study involved 16 female subjects. Three split-face procedures were performed using two concentrations of GLA solution applied on two sides of the face. The skin parameters were measured before treatments and 7 days after the last procedure at four measurement sites on either side of the face, that is, on the forehead, around the eye, on the cheek, and on the nose wing. Measurement of sebum demonstrated some statistically significant changes between sebum levels in the cheeks after a series of treatments. The pH measurement showed that the pH value was reduced after each treatment at all measurement points. The level of TEWL after treatments was significantly lower around the eyes, on the left forehead, and on the right cheek. There were no significant differences between the use of different concentrations of the GLA solution. The results of the study show that GLA has a significant influence on lowering skin pH and TEWL. GLA also has seboregulatory properties.

Nasal Malignant Melanoma With an Inverted Papilloma in the Contralateral Nasal Cavity: A Case Report.

Background: We describe a patient with sinonasal mucosal melanoma (SNMM) and an inverted papilloma, which existed independently in both nasal cavities. Case presentation: We describe an unusual case of a 74-year-old male patient with SNMM and an inverted papilloma. He presented with symptoms of coughing up blood and pain in the left forehead. The patient underwent surgical resection of the lesion, and the SNMM and inverted papilloma were confirmed by histopathology. The patient refused further treatment after surgery, but was re-admitted 7 months later with local recurrence of the left tumor and systemic metastases. Conclusions: Nasal malignant melanoma with an inverted papilloma in the contralateral nasal cavity is rare and can easily be misdiagnosed as the same tumor by imaging. Simultaneous histopathology of bilateral nasal masses is very necessary. The recommended treatment is surgery for the inverted papilloma. An SNMM is a devastating tumor with poor outcomes.

Reoccurred Multiple Basal Cell Carcinomas: A Case Report

Basal cell carcinoma (BCC) is the most common skin cancer. Ultraviolet radiation exposure and genetic predisposition are known to be the most important etiological factors. Multiple BCC is often associated with genetic familial conditions such as BCC syndrome, basal cell nevus syndrome. We present a case of 54-year-old female who had multiple BCC that had reoccurred. She was completely cured after receiving radio-chemotherapy for leukemia 16 years ago. She had multiple lesions (scalp, left thigh, right popliteal fossa, and right buttock), and had underwent wide excisions of all lesions. All biopsies revealed BCC. Six years later, she had also multiple lesions; left forehead, frontal vertex scalp, parietal vertex scalp, right occipital scalp, and lower abdomen. We performed wide excision. Histopathological examination revealed BCC. She had no signs of any BCC associated syndrome. We report a rare case of nonsyndromic multiple BCC that reoccurred at the new site.

Hypertrophic herpes simplex virus 2 infection resistant to acyclovir in an immunosuppressed patient.

KEY POINTS An 80-year-old man on ruxolitinib for myelofibrosis was referred to the infectious diseases clinic with a subacute, progressive mass over his left forehead. He also had type 2 diabetes mellitus and dyslipidemia, and was taking rabeprazole, simvastatin and metformin. Three years before

HERPES ZOSTER OPHTALMICUS IN AN IMMUNOCOMPETENT PATIENT

HZO (Herpes Zoster Ophthalmicus) is defined as the reactivation of VZV (Varicella Zoster Virus) in the ophthalmic branch of the trigeminal nerve, leading to the appearance of well-demarcated erythematousvesicular lesions along the dermatome. Antiviral therapy is mandatory and preferably initiated within the first 72 hours of the rash onset, as it is most effective in preventing ocular involvement. Raising awareness of the importance of early diagnosis and management of herpes zoster ophthalmicus, with the involvement of an ophthalmologist is critical in limiting visual morbidity. We present a 40-year-old patient without significant medical history or background treatment, immunocompetent, whose symptoms began suddenly with a few erythematous- vesicular lesions on the left fronto-parietal scalp preceded by burning pain and hyperesthesia. At her first medical exam, she was recommended antiviral treatment with oral acyclovir and cortisone. She was admitted in our clinic 48 hours from the onset, with the extension of the lesions to the left forehead and peri-orbital, periorbital itching, left occipital hypoesthesia, and painful pre-, retro-auricular, and left latero-cervical lymphadenopathy. Intravenous antiviral treatment with acyclovir was started (7 days), and corticosteroid therapy was discontinued, with a favorable outcome. The particularity of this case lies in the reactivation of VZV in an immunocompetent patient, with a sudden onset and rapid progression. Additionally, the initial suspicion of diagnosis was not supported by the subsequent course of the disease, and corticosteroid treatment was discontinued. It is important to perform a differential diagnosis correlated with each stage of the disease to avoid inappropriate therapeutic management, which can have long-term adverse effects on the patient.

En Coup De Sabre in 16-Year-Old Girls: A Case Report

Background: En coup de sabre (ECDS) is one of the clinical variations of morphea. ECDS refers to a variant of linear morphea that usually involves the forehead and frontal scalp that may be associated with alopecia. This study aimed to describe a case of en coup de sabre with its diagnosis and management.&#x0D; Case presentation: A girl, aged 16 years, came to the dermatology polyclinic with the main complaint of a sunken brown spot on the left forehead and corner of the left eye, which has been expanding since 2 months ago. This complaint does not feel itchy or painful, but because it is getting more widespread, patients feel embarrassed and often cover it up. On dermatological examination, depressed hyperpigmented macules, plaque size, firm boundaries, and location on the left medial superior lid and left medial glabella were found. On dermoscopy examination, a reticular pigment network obliterating the follicular opening was found. The results of the histopathological examination showed the impression of a linear morphea type with en coup de sabre. This patient was diagnosed with linear morphea type with en coup de sabre&#x0D; Conclusion: En coup de sabre is a rare autoimmune disorder and is a subtype of morphea. Early detection and appropriate intervention will reduce disease progression.

Frontal midline theta rhythm and gamma activity measured by sheet-type wearable EEG device.

The current study measured the frontal midline theta rhythm (Fmθ), which appears in the frontal midline region during the attentional focus state, using the sheet-type wearable electroencephalograph (EEG) device HARU-1, and examined the modulation of frontal gamma band activity by cognitive tasks. We measured the frontal EEG of 20 healthy subjects using HARU-1 for 2 min during the rest eyes-closed condition and simple mental calculation task condition, respectively. Statistical analyses were conducted using permutation testing based on t-test and cluster analysis to compare the results between the resting state and the task condition. Twelve of 20 subjects showed Fmθ during the task condition. The 12 subjects with Fmθ showed significantly higher activity of the theta and gamma bands, and significantly low activity of the alpha band during the task condition compared to the resting condition. In the eight subjects without Fmθ were significantly low activity of the alpha and beta bands and no significant activity in the theta and gamma band activity during the task condition compared to the resting condition. These results indicate that it is possible to measure Fmθ using HARU-1. A novel finding was the gamma band activity appearing with Fmθ in the left and right frontal forehead regions, suggesting that it reflects the function of the prefrontal cortex in working memory tasks.

Death In The Case Of Suspected Neck Fractures Due To Blunt Trauma; A Case Report

Blunt trauma is a forced force caused by a blunt object on the surface of the body that causes injury. Cervical fracture will compress the upper respiratory tract which will result in death due to asphyxia. Found a female body, known, aged 55 years. Found bruises on the back of the neck, waist, thighs missing on compression. corpse stiffness and decomposition is not found. There were lacerations on the head and left forehead, both lips, the tips of the fingers of both hands and the tips of the fingers of both feet were bluish in color, and there were signs of a cervical fracture. From the results of external examination, theory and discussion above, it can be concluded that the cause of death of the victim was suspected to be suffocation due to a fractured neck due to blunt trauma.

Primary extranodal soft tissue Lennert lymphoma (lymphoepithelioid variant of peripheral T-cell lymphoma, unspecified): a case report and review of the literature

Lennert lymphoma (LeL) is a rare variant of peripheral T-cell lymphoma, not otherwise specified (PTCL/NOS) that is rich in epithelioid histiocytes. LeL may pose great diagnostic and therapeutic challenges to the pathologist and clinician. Primary extranodal soft tissue LeL is even rarer and has not been reported. Herein, we report a case of LeL arising from soft tissue.A 65-year-old male presented for evaluation of a painless mass in the subcutaneous soft tissue of the left forehead. There was no invasion of the bone and no ulceration on the surface of the skin. The surrounding skin was erythematous and swollen. Grossly, the tumor was gray-red and 30 mm × 20 mm × 10 mm in size.Microscopically, the demarcation between the lesion and surrounding tissues was unclear without a capsule. The tumor invaded the surrounding striated muscle and adipose tissue. The tumor had a diffuse proliferation of small-sized atypical lymphocytes and numerous large clusters of epithelioid histiocytes. Plasma cells, eosinophils, and Hodgkin-Reed-Sternberg (HRS) cells were not identified. Rare multinucleated histiocytes were noted, and well-formed granulomas were not present. Rare mitotic figures were noted, but no necrosis. The immunophenotypic features in this case were as follows: CD2+/CD3+/CD5low+/CD7+/CD4low+/ CD8+/CD30−/CD56− in neoplastic lymphocytes; CD163+/CD31+/CK(pan)− in epithelioid histiocytes; and CD20−/CD30−/TdT−/CD5−/ALK−/S-100−/CD1α−/CD21 + 23−/SSTR2− in neoplastic lymphocytes and epithelioid histiocytes. Epstein-Barr virus (EBV)-encoded RNA in situ hybridization (EBER-ISH) was negative. The Ki-67 index was elevated to 60%. PCR showed a polyclonal pattern for IgH and a monoclonal TCR γ-chain rearrangement.The final diagnosis was PTCL/NOS, lymphoepithelioid cell variant (LeL), which arose from soft tissue and had a rare double-positive CD4low+/CD8+ immunophenotype. The patient received four cycles of cyclophosphamide, doxorubicin liposomes, vincristine, and prednisone tablets (CHOP) and was followed for 20 months. Overall treatment efficacy was achieved without lymphadenopathy, and no other discomfort or illnesses were reported.

Negative Pressure Therapy for Treatment of Wounds with Exposed Bone and Dura

Introduction: Previous dogma has rejected that it is safe to apply a wound vacuum dressing directly onto the brain dura without a barrier. This case presents successful wound healing in a patient with previous failed free flap and skin grafting of her frontotemporal craniotomy wound with wound vacuum dressing application. Case Presentation: The patient is a 76-year-old female with a past medical history of an osseous meningioma who has undergone four prior resections (1994, 2002, 2012, 2021). She underwent her last craniotomy and resection with neurosurgery, leaving a large frontotemporal defect. At that time, a local flap was utilized by extending the resection incision pre- and post-auricular in a “face lift” fashion to gain closure of 95% of the defect. After two months, she returned to the OR due to loss of two areas of the local flap, anteriorly over the left forehead and posteriorly near the rotation point just superior to the ear. There was exposed bone and cranioplasty. A bipedicle fasciocutaneous flap was then created from the left frontal hairline to the midline occipital region with supraorbital and left occipital artery vascular supply. A split-thickness skin graft was applied to the posterior area that was still uncovered. She continued to experience complications with necrosis of areas of the skin flap, which included an additional cranioplasty and attempted local flap coverage, as well as a radial forearm free flap. Flap healing was complicated by pseudomonas infection, which caused partial failure with an area of exposed bone and scarred dura. Management and Outcomes: A black sponge wound vacuum dressing with silver impregnated barrier dressing was applied to the area on the non-wound side of the sponge. Over the course of three months, the patient experienced marked reduction in the size of the wound with progressive closure. Discussion: There has been literature on the benefit of wound vacuum assisted closure in complex wounds and reconstructions in various parts of the body with evidence of reduced surgical site infections and wound necrosis. However, evidence of benefit in scalp reconstruction is largely limiterrd to case series and reports. In these described case reports patients had improved outcomes with fewer dressing changes, and increased success with subsequent skin grafts. Similarly, our patient underwent wound vacuum therapy, after recurrent chronic wound infection with bony defect and recurrent flap failure. She had improved wound healing, resolution of infection and decrease of the defect size. Conclusion: In conclusion, there is a potential bernefit to using wound vacuum assisted therapy in scalp defects that have failed previous reconstruction attempts that merits serious consideration. In this case, it has allowed for better wound healing and has allowed the patient an improved quality of life. Corresponding Author: Yitzchok Greenberg, 2799 W Grand Bvd, Detroit, MD 48202; 313-673-7190