Less lethal projectile wound pattern identification using synthetic skin.

Neuro-bone-skin tri-regeneration via a microenvironment-responsive PRP-loaded chitosan hydrogel for traumatic brain injury therapy.

Radiated chronic scalp wounds with exposed bone present a significant reconstructive challenge, particularly when prior attempts have failed or when further surgery is contraindicated due to patient comorbidities or preference. We retrospectively reviewed 10 patients (2014-2024) with radiated chronic scalp wounds with exposed bone who have either failed prior reconstruction, could not medically tolerate anesthesia, or declined surgery. Patients performed daily cleansing with soap and water followed by application of Aquaphor and Silvadene. Treatment duration ranged from 1 to 73 months (mean: 29.4mo). The area of exposed bone decreased in 6 patients (60%), remained stable in 1 (10%), and increased in 3 (30%). Three of 7 patients with wound improvement (30%) achieved complete healing. Two of 3 patients with wound progression deceased of unrelated causes. To our knowledge, no major complications occurred. These findings support wound care as a safe, and often effective, treatment when larger reconstruction is not feasible.

Background: Electric burn and machinery avulsion injury at scalp is very common in developing country like us. Early coverage by local flap may reduce extra cranial and also intracranial complication. To see long term functional and cosmetic outcome of local transposition/rotation scalpflap. Materials and methods: It is a prospective observational study to find out long term effect of local transposition flap over scalp/Calvarial wound.18 patients of scalp wound were included in this study with 14 male and remaining 4 were female for last 3 years (July 2022 to June 2025). Average age limit 32 years (7 years to 59 years). Patient of scalp wound actually caused by high voltage electric burn, tumour excision, bullet injury, machinery avulsion injury and road traffic accident. Five patients need intensive care unit and neurosurgical treatment for head injury. Results: All 18 patients under gone local transposition/ rotation flap for scalp wound. Only three of 18 flapshave marginal necrosis which gradually healed by dressing. Long term follows up shows complete functional and cosmetic recovery. Follow up X-ray skull shows good healing at bone and no evidence of osteomyelitis. All doner site of scalp flap covered with split thickness skin graft which remain hairless at long term follow up. Conclusion: Local subgaleal transposition/rotation scalp flap is the good option for scalp defect for variety of wound. Early coverage can prevent life threatened complication like brain abscess, CSF leakage and osteomyelitis. JCMCTA 2025 ; 36 (2) : 151-155

Visible signs of possible concussion at the FIFA World Cup Qatar 2022™: Independent review and inter-rater reliability.

When the Skin Lies: Occult Scalp Necrotizing Fasciitis After Blunt Head Trauma.

Implications of cranial pinning during awake craniotomy on anesthetic requirements: A retrospective cohort study.

Fibroblasts of disparate developmental origins harbor anatomically variant scarring potential.

<h3>ABSTRACT</h3> <h3>Introduction:</h3> Extensive scalp wounds following trauma, particularly burns, present a significant reconstructive challenge. Multidisciplinary long-term care is required to restore function and aesthetics while minimizing complications. <h3>Methods:</h3> We report a 35-year-old male with second- and third-degree burns covering 70% of his body, including face, trunk, and upper limbs. Scalp reconstruction involved tissue expansion, rotational flaps, partial-thickness skin grafts, and multiple follicular unit excision (FUE) hair transplant sessions. <h3>Results:</h3> Scalp expansion and flap rotation reduced scarred areas but left residual alopecia, which was successfully treated with four FUE sessions (totaling 2,946 scalp and 1,468 beard follicular units), achieving near-complete restoration. Graft survival was satisfactory, and the patient regained functional and aesthetic outcomes, with reintegration into social activities. <h3>Discussion:</h3> Multimodal reconstruction, including biologic dressings, scalp expansion, and staged hair transplantation, is effective for post-burn scalp alopecia. Challenges include reduced vascularization, fibrosis, tissue rigidity, prolonged hospitalization, increased risk of infection, and other clinical complications, which require careful planning and multiple procedures to optimize graft survival. <h3>Conclusion:</h3> Complex scalp reconstruction in burn patients is feasible with a combination of advanced wound care, tissue expansion, skin graft, flap rotation, and FUE transplantation, leading to durable aesthetic and functional outcomes.

ABSTRACTHair loss associated with inflammatory scalp conditions is a growing clinical challenge. However, current FDA‐approved treatments primarily stimulate hair growth without targeting the underlying oxidative stress or immune‐related damage. In this study, we developed a topical, bioactive composite composed of amine‐activated carboxymethyl chitosan (aaCMC) and hydrolyzed decellularized extracellular matrix (h‐dECM), formulated using a dual supercritical fluid system to ensure solubility and enhance skin penetration. The resulting formulation exhibited antioxidant activity, immunomodulatory effects, and promoted extracellular matrix (ECM) remodeling in vitro. Specifically, the aaCMC + h‐dECM composite reduced intracellular reactive oxygen species (ROS) levels and suppressed p38 phosphorylation in human dermal papilla cells, indicating the inhibition of senescence‐related pathways. It also attenuated pro‐inflammatory cytokine secretion in activated human peripheral blood mononuclear cells and significantly upregulated collagen and fibronectin expression in human dermal fibroblasts. In vivo, the composite accelerated epidermal repair and hair follicle regeneration in a UVB‐induced scalp injury mouse model, demonstrating superior regenerative outcomes compared with minoxidil. These results suggest that aaCMC + h‐dECM is a multi‐functional regenerative platform capable of restoring scalp homeostasis through the combination of ROS modulation, immune regulation, and ECM support. This strategy may provide a multi‐functional therapeutic alternative to conventional monotherapies for inflammatory hair loss.

Scalp burns pose a unique challenge to the reconstructive surgeon given the anatomical characteristics of the head and neck. This challenge is magnified in severe burn injuries extending to the calvarial bone. Several algorithms for scalp and calvarial reconstruction have been presented in the past. However, no consensus exists about the optimal reconstructive approach. Our aim is to develop a novel algorithm for scalp burn reconstruction based on the relevant literature as well as case observations from the growing multidisciplinary field of neuroplastic surgery. A literature review of articles on PubMed, SCOPUS, and Web of Science focused on scalp and calvarial burn management was conducted. We also present relevant cases from our institution that demonstrate the neuroplastic surgery approach to reconstruction of complex burns in this region. An algorithmic approach based on relevant anatomy, reconstructive principles, and surgical techniques ranging from primary closure to cranioplasty to reconstruct scalp and skull defects following burns is proposed. A novel algorithmic approach based on the Harrison classification of injury was developed based on our literature review. We also present 2 relevant cases from our neuroplastic surgery practice. We determined that the initial and most important factor in scalp and calvarial management is the integrity of the pericranium. Other factors such as patient's compliance and cosmetic needs may also determine treatment approach. Management of scalp burns can be simplified using an algorithmic approach. We anticipate this work will help guide and improve reconstructive management for scalp and calvarial burn patients for reconstructive surgeons, burn surgeons, and particularly surgeons in resource-poor settings faced with treating severe scalp and calvarial burns.

Cortical bone fenestration with a Beaver scalpel blade to promote second intention healing of Mohs surgery scalp wounds: report of 2 cases

Scalp injuries resulting from road traffic accidents (RTA) often present complex challenges due to the need for both functional and aesthetic restoration. Rotational flap surgery is a well-established technique in reconstructive surgery that allows for effective coverage of scalp defects while preserving vascular integrity.

In complex cranial wound closures, plastic and reconstructive surgeons provide advanced techniques to improve healing and reduce complications, including infection. Although this multidisciplinary approach shows promise, data supporting its routine use remain limited. The authors performed an evaluation of neurosurgical patients requiring plastic and reconstructive surgical interventions for complex scalp wounds to assess the reconstructive techniques used and associated outcomes. A retrospective analysis was conducted on patients jointly treated by neurosurgery and plastic and reconstructive surgery at the University Hospital Zurich in the period from 2016 to 2023. Patients aged 16 years or older with informed consent were eligible for inclusion. Collected data encompassed demographics, primary diagnoses, wound healing risk factors, procedural details, and outcomes. Thirty-seven patients with a mean age 60.8 years were included in the study; 56.8% were female. Most cases were oncological (73.0%), and among this group, 51.3% had received prior radiotherapy. Overall, patients had a mean of 3.8 previous cranial surgeries. Preexisting wound healing impairment or infection was present in 64.9% of patients. A total of 47 procedures involved plastic and reconstructive surgeons, whose involvement was secondary (after failed primary closure) in 85.1% of cases. Free flaps (46.8%) and local flaps (38.3%) were the most common reconstructions. Postoperative local scalp wound complications occurred in 34.0% of cases (16/47), and 25.5% (12/47) required rehospitalization for revision surgery. No free flap failures occurred. The mean operating time was 266.5 minutes, and the mean hospital stay was 12.4 days. Patients with complex scalp defects, especially after multiple surgeries or radiotherapy, remain at high risk for wound complications and infection despite advanced reconstruction. Early plastic and reconstructive surgeon involvement and interdisciplinary planning may be helpful in reducing infection risk and improving outcomes. Proactive identification of high-risk cases for plastic surgery consultation is recommended to enhance wound closure and prevent cranial wound infections. Prospective studies are needed to confirm these strategies.

Pediatric scalp injuries caused by agricultural machinery are rare but potentially devastating with long-term implications on craniofacial growth and psychosocial development. These injuries present unique reconstructive challenges due to the scalp’s limited elasticity, robust vascularity and the need to preserve both function and cosmesis in a developing child. This report describes the staged surgical management of a 1.5-year-old boy who sustained extensive scalp lacerations and calvarial fractures following entrapment of scalp hair in a rice-cutting machine. Initial wound closure was followed by partial flap necrosis. Then a secondary procedure involving transposition flap reconstruction and split-thickness skin grafting (STSG) was performed. This case underscores the importance of a systematic, adaptive reconstructive strategy, adherence to the principles of the reconstructive ladder and long-term multidisciplinary follow-up. Psychological support, parental counseling and vigilance for late sequelae were integral components of care. Journal of Paediatric Surgeons of Bangladesh (2021) Vol. 12 (1 &amp; 2): 41-44

Traumatic wounds present complex challenges due to tissue loss, contamination risk, and delayed healing, often requiring resource-intensive interventions such as negative pressure wound therapy, grafting, or repeated clinical visits. There remains an unmet need for affordable dressings that not only protect but also foster a stable wound environment and enable at-home management. The collagen–honey–hydroxyapatite dressing (CHD) combines collagen, Mānuka honey, and hydroxyapatite which are known to provide structural support, regulate inflammation, reduce bacterial burden, and promote angiogenesis and granulation. This case series reports outcomes in three patients with diverse traumatic wounds. Patient A, a healthy 26-year-old male with a puncture wound, achieved complete closure by Week 4. Patient B, an 88-year-old female with multiple comorbidities and a dog-scratch laceration, achieved closure by Week 6. Patient C, a 91-year-old male with a scalp wound complicated by prior radiation therapy and infection, demonstrated a 92% reduction in wound area by Week 4.5 despite travel-related treatment gaps. Across all cases, the CHD supported rapid granulation, wound stabilization, and steady progression toward closure, while enabling simplified at-home application. These findings suggest the CHD may represent a cost-effective, patient-centered alternative for traumatic wound management.

Traumatic scalp injuries represent a significant challenge in plastic and reconstructive surgery due to the anatomical complexity of the region and the need to restore both protective function and aesthetics. The scalp, composed of multiple layers (skin, subcutaneous tissue, galea aponeurotica, loose areolar tissue, and pericranium), is a richly vascularized structure that protects the skull and brain. Defects resulting from trauma can vary in size and depth, from small lacerations to extensive avulsions that expose the cranial bone, compromising structural and functional integrity, and severely affecting the patient's quality of life [1, 3, 9]. Successful post-trauma scalp reconstruction not only aims to close the defect but also to restore protective coverage, preserve hair function, and achieve an acceptable aesthetic outcome. Over the years, various surgical techniques have been developed, ranging from primary closure and skin grafts to the use of local, regional, and microvascularized flaps, as well as tissue expansion and the use of dermal substitutes [1, 4, 7, 8, 12]. The choice of the optimal reconstructive technique depends on multiple factors, including the size and location of the defect, the presence of healthy surrounding tissue, bone exposure, the patient's age and comorbidities, and the surgeon's experience [3, 10, 12]. This systematic review article aims to provide an updated overview of contemporary techniques in post-trauma scalp reconstruction. It focuses on the most recent and relevant medical literature published in plastic surgery journals over the last 5 to 8 years, in order to synthesize surgical innovations, treatment algorithms, and reported outcomes. This review seeks to be a comprehensive guide for medical professionals and researchers interested in the advanced management of traumatic scalp defects, contributing to the improvement of reconstructive strategies and, ultimately, to the optimization of patient outcomes.

BackgroundAdvancements in prenatal diagnosis and obstetric care have changed the epidemiology of neonatal birth trauma in developed countries. Improving women's access to health care is key to preventing, detecting, and treating conditions that increase pregnancy complications and adverse neonatal outcomes.ObjectiveTo identify new risk factors—focusing on social determinants of health—and short-term outcomes associated with neonatal birth trauma.Study designTerm neonates with unexpected complications born between January 1, 2019, and March 31, 2023, at 10 diverse hospitals in our health system were identified using Perinatal Care-06 coding. Maternal and neonatal charts were reviewed and recorded in REDCap. Neonates with and without birth trauma were assigned to case and control groups, respectively. Risk factors were identified using Pearson chi-square tests and multivariable logistic regression.ResultsOf 711 neonates, 187 (26.3%) experienced birth trauma, primarily scalp injuries (Caput Succedaneum 42%, Ecchymosis/Bruising 27%). There were no significant differences in race, language barriers, insurance type, marital status, prenatal care access, mean household income (zip code), gestational age, maternal height, birth weight, or head circumference (all p > 0.05). Significant differences were observed in maternal age (p = 0.042), gravidity (p = 0.04), and parity (p = 0.002), with affected mothers being younger, with fewer pregnancies and lower parity. Mothers with chronic or gestational hypertension, with or without preeclampsia, had higher odds of neonatal birth trauma (OR = 1.582, 95% CI: 1.081–2.316, p = 0.018). Emergent deliveries nearly tripled the odds (OR = 2.8, 95% CI: 1.934–4.054, p < 0.001). Neonates exposed to maternal epidural anesthesia were more likely to suffer from birth trauma (77.5 vs. 51.7%, p < 0.001).ConclusionSocial determinants and prenatal care access did not significantly impact birth trauma. However, hypertension, exposure to epidural anesthesia and emergent delivery were associated with an increased risk.

Myiasis is a parasitic infection common in tropical areas, such as Brazil. It is caused by infestation of maggots of various fly species in humans. Here, the case of a 38-year-old female patient, with no comorbidities, who was referred to the authors' centre due to a scalp wound infested with larvae and complete soft tissue loss, is presented. A computed tomography scan revealed no evidence of osteomyelitis or intracranial compromise. Since the initial debridement and mechanical removal of the larvae resulted in a large and complex wound, the patient underwent a combined wound approach based on cranial burr holes and negative pressure wound therapy followed by skin graft. The wound revealed excellent skin graft survival, and the patient was safely discharged home. No complications were observed in the follow-up period.

A middle-aged patient presented with persistent purulent discharge from a scalp incision five years after undergoing craniotomy with artificial dura mater implantation. The wound showed no significant improvement despite a month of systemic antibiotic therapy and local debridement. Subsequent superficial ultrasonography revealed complete separation of the artificial dura mater implant area from the surrounding flap tissue, with a loss of local blood supply. Based on these findings, the artificial dura mater was surgically removed, and a free skin flap transplantation was performed to successfully cover the wound. The wound was well-healed at the 10-month postoperative follow-up.