Scalp Wound Research Articles

The advent of epilepsy directed neurosurgery: The early pioneers and who was first

ABSTRACT Efforts to treat epileptic seizures likely date back to primitive, manmade skull openings or trephinations at the site of previous scalp or skull injuries. The purpose may have been the release of “evil spirits,” removal of “cerebral excitement,” and “restoral of bodily and intellectual functions.” With progressive discoveries in brain function over the past 100 to 300 years, the cerebral cortical locations enabling voluntary movements, sensation, and speech have been well delineated. The locations of these functions have become surgical targets for the amelioration of disease processes. Disease entities in particular cerebral-cortical areas may predispose to the onset of focal and or generalized seizures, which secondarily interfere with normal cortical functioning. Modern neuroimaging and electroencephalography usually delineate the location of seizures and often the type of structural pathology. If noneloquent brain regions are involved, open surgical biopsy or removal of only abnormal tissue may be undertaken successfully. A number of the early neurosurgical pioneers in the development of epilepsy surgery are credited and discussed in this article.

Fall or homicide...? The imbroglio answered at autopsy...!

Homicide is one of the most dreaded consequences of interpersonal conflicts, culminating in ending the life of a person. Cases involving attempts to camouflage homicidal incidents with the accidental ones are not entirely unknown in forensic medicine. Most of the time however, neither medical science nor the law gain expected success in either curbing or unearthing such incidents, so there remains a great possibility of perpetrators escaping a meticulously planned homicide that has been disguised either as a suicide or as an accidental death. In such cases, the role of a scrupulous autopsy is of paramount importance to surface the truth. A careful observation and interpretation of the injuries in dubious circumstances may occasionally reveal an entirely unprecedented story and thereby the cause and manner of death. A case related to a young adult male is herein presented who was initially brought dead to the emergency dept. with an alleged history of assault leading to a blow over his head. In the inquest papers, however, his acquaintances stated the injury to be sustained from an accidental fall in the street. At autopsy, a discrepant location and form of the scalp injury and the additional findings suggestive of manual strangulation and kicking and/or stomping resulted eventually into an opinion of homicide. The characteristic postmortem findings and attempted circumstantial and crime scene alterations by the possible perpetrators are highlighted. The results of a modeled wound-weapon profiling that was carried out later to link the alleged crime weapon with the injury profile, are shown.

Outcomes of Cranioplasty Reconstructions: Review of Cranioplasty Implants and Free Flap Coverage Variables that Affect Implant Exposure.

Complex scalp wounds with cranial/dural involvement are challenging to reconstruct. Successful reconstruction can be achieved with cranial implants/hardware and free flap coverage. Wounds can breakdown and require revision procedures. We addressed reconstructive outcomes of different implants requiring free flaps. To determine the factors associated with implant exposure. Multi-institutional retrospective review of 82 patients, 2000-2020, repaired with cranial implants and free flap coverage. Implant exposure occurred in 13/82 (16%) reconstructions. Flap atrophy or thinning leading to implant exposure occurred in 11/82 (13%) reconstructions, including partial flap atrophy OR 0.05 (95% CI 0.0-0.35) and total flap atrophy OR 0.34 (95% CI 0.02-19.66). Revision surgeries that occurred subsequent to flap reconstruction were also associated with implant exposure (OR 0.02 (95% CI 0.0-0.19)). Implant exposure was not associated with radiation therapy, patient health history, implant type, flap type, or postoperative complications. Implant exposure is associated with free flap atrophy, leading to inadequate implant coverage and the need for revision surgeries. Completing reconstruction with adequate soft tissue bulk and coverage and avoiding revision surgery may decrease the risk for implant exposure over time. 4 Laryngoscope, 133:2954-2958, 2023.

Epidemiological Trends of Traumatic Nervous System Injuries in a Tertiary Health Institution during the First Year of the Coronavirus Disease 2019 Pandemic in Turkey.

Traumatic nervous system injuries (TNSIs) remain one of the most debilitating injuries globally, including in Turkey. Despite its popularity, epidemiological studies revealing the true incidence of TNSIs in our country are scarce. This study aims to document the epidemiological trends of TNSIs in the first year of the coronavirus disease 2019 pandemic in Çorum, Turkey. This retrospective cohort study was conducted to analyze the incidence of TNSIs in patients admitted to the emergency department (ED) of a tertiary hospital in Çorum from March 1, 2020, to February 28, 2021. Of the 107,100 patients admitted to the ED, 492 (0.4%) were diagnosed with TNSIs. Traumatic head injuries (including scalp and calvarial injuries), traumatic brain injuries (TBIs, excluding scalp and calvarial injuries), traumatic spinal injuries (TSIs), and traumatic peripheral nerve injuries were detected in 262 (53.2%), 141 (28.6%), 268 (54.4%), and 9 (1.8%) patients, respectively. Overall, male predominance was 2/1 (male/female), with a mean age of 45 years. The main cause of trauma was falling (61%), followed by motor vehicle collisions (26%). This was mostly scalp injuries (59%) and calvarial fractures (42%), while subdural (12.8%) and subarachnoid (11.1%) hemorrhages were the predominant TBIs. The majority of TSIs were detected in the lumbar spine (66%). Conservatively treatment was administered to 432 (88%) patients, and 424 (86%) patients recovered completely, while 33 (7%) survived with some degree of motor, sensory, or sphincter deficits, and 35 (7%) died. This study reveals findings that will effectively guide the steps to increase public health awareness and preventive measures regarding TNSIs in our country.

Hyalomatrix coverage in scalp wounds with exposed cranium and dura

The armamentarium of options available for soft tissue reconstruction of the scalp spans the reconstructive ladder. The purpose of this paper is to describe a case series of patients with exposed cranium and dura who were successfully reconstructed using esterified hyalomatrix (eHAM, Hyalomatrix, Medline Industries Inc., US). After obtaining Institutional Review Board approval, a retrospective review of the senior author's (ALF) patient database was completed. Patients who underwent scalp reconstruction using eHAM were identified. Each patient's chart was reviewed and data collected on demographics, days to skin graft, duration of follow-up, pathology, comorbidities and complications. This case series consisted of five patients aged ≥18 years, with scalp wounds exposing dura or cranium, who were treated with eHAM as a bridge to definitive coverage with a skin graft. Each wound successfully granulated the exposed critical structure with the use of the eHAM. The mean time to skin graft coverage was 41 days, with a range of 13-79 days. Of the series of five patients, four had a follow-up of ≥12 weeks. The mean defect size was 90.2cm2. Complex scalp reconstruction can be accomplished using healing by secondary intention, skin grafts, local flaps, tissue expansion and free tissue transfer. As shown in this case series, another option available in select patients is using a dermal substitute such as eHAM. This is one treatment option available to reconstructive surgeons in multiple specialties.

Scalp Reconstruction Techniques for the General Surgeon – A Case Report

Scalp injuries are extremely common and although most scalp lacerations/ injuries can be primarily repaired, few require flap coverage. This article discusses the various ways in which we have reconstructed the scalp. This article is a case series of six different cases that required flap reconstruction where six different techniques were used to obtain wound cover with good outcomes. Patients who presented to various smaller hospitals/nursing homes with availability of only a general surgeon and no super specialists in Rural Bangalore with the need for scalp reconstruction were considered for the study. The operative outcome of six different methods of scalp reconstruction/ repair that include four different local flaps, a split skin graft with a wig and a pericranium burr hole drilling followed by split skin graft coverage have been studied.
 All six cases were followed up for a period of one month post intervention and all of them had good functional and cosmetic outcomes with no complications. There was no incidence of surgical site infection, seroma, or flap/graft failure in the 6 cases included in our study. Both grafts and flaps are equally good modalities in scalp reconstruction, but the choice for which to use should be based on the need of the patient and the type of wound. Grafts can be considered in conditions where there is adequate soft tissue cover over the scalp and in wounds with larger surface area. Grafts have the advantage of being technically simpler and are associated with fewer complications/failure but cannot be used in injuries where the bone is exposed. Flaps have better cosmetic outcome but are technically more challenging.

Some experiments and remarks regarding the possible formation of blood stains on the Turin Shroud: stains attributed to the crown of thorns, the lance wound and the belt of blood.

The Turin Shroud (TS) is a Christian relic interpreted to be the burial cloth of Jesus of Nazareth. It exhibits red discolorations that have been interpreted as blood stains and that are the subjects of a highly controversial discussion. We conducted experiments to identify theoretically possible explanations for the stains attributed to the crown of thorns, the lance wound and the belt of blood.In the experiments with a focus on the stains attributed to the crown of thorns, a very similar stain pattern as on the TS could be provoked by simulating the following sequence of events: blood from antemortem scalp wounds is covering hair and face; blood is coagulating and/or drying; blood components are mobilised by postmortem washing and oiling.A stain pattern very similar to the belt of blood on the TS was successfully provoked by simulating the following sequence of events: The body is lying in a supine position, blood or bloodied water flowing from a wound at the right lateral chest wall; the body is rotated to the left side; the Shroud is tucked under the back; the body is rotated back to a supine position and laid onto the Shroud. The so-called serum ring surrounding the stain attributed to the lance wound could be reproduced by sequential application of serum and whole blood samples or of pleural effusion and whole blood samples onto cotton cloth.It is obvious that any attempt to interpret the assumed blood stain pattern on the TS has serious limitations. Nevertheless, it seems remarkable that we were able to reproduce findings that appear to be very similar to stains on the TS.

“Unshaved Intradermal Running Suture for Elective Cranial Neurovascular Surgeries”

In this paper, we analyze the experience and propose a method of incision and stitching of the postoperative scalp wound without shaving hair in elective neurosurgical interventions. Between January 2021 and May 2022, 44 patients with various neurovascular pathologies were included in the study. The age of the patients varied from 28 to 58years. All patients underwent elective surgical interventions with intradermal cosmetic sutures without shaving hair. The results of published observational series of neurosurgical patients with unshaved hair were also analyzed. Treatment of the surgical field, scalp, and incision were performed without shaving hair in 44 cases. The technique of intradermal suture without shaving hair was used in 31 cases of the classical pterional approach, in 11 cases of minipteronal, in 1 case of parasagittal, and in 1 case of retrosigmoid suboccipittal approaches. The mean age of the patients was 47.5years (±8.82). The average length of stay in the clinic was 8.02days (±2.04). The sutures were removed on the fifth-eighth day. All cases were operated on for elective neurovascular interventions: aneurysms without rupture (95.4%), arteriovenous malformations (2.3%), and cavernous angiomas (2.3%). All but one patient (2.3%) had no wound complications-the suture ruptured at the stage of its removal from the skin. Our results also show that the use of a nonresorbable intradermal suture combined with hair preservation does not affect the risk of infection.

Role of External Tissue Expansion Wound Closure in the Electrical Burn Wound to the Scalp

Electrical burns constitute 3–5% of all burn cases; in developing countries, this ratio increases up to 21–27% and the mortality rate is reported to be between 3.75% and 58.8%. Most of the acute burns are life threatening, and require various types of surgical interventions such as eschar excision or split thickness skin grafting, depending on the size, location and depth of the lesion. The deep electrical burns to the scalp were difficult to manage as it was more prone to exposure of the calvarial bone. In our case, a calvarial bone at the vertex was exposed post-eschar excision. Tissue expansion is based on the principle that all living tissues respond in a dynamic fashion to mechanical stress placed on them. Below we present a case of electrical burns wound to the calvarium utilizing the use simple cost-effective external tissue expansion technique for preventing wound retraction and for holding the dressing of the scalp wound.

Saving the Exposed Deep Brain Stimulation Implant: A Comprehensive Review of Implant Extrusion and Reconstructive Options

Deep brain stimulation (DBS) for the treatment of Parkinson disease is susceptible to complications, such as hardware extrusion, most commonly at the scalp and chest. The authors describe their experience with the management of hardware extrusion and reconstruction with one of the largest single-institution experience and suggest an evidence-based treatment algorithm for the management of such cases. A retrospective review of hospital records was performed to identify patients who underwent DBS-related surgery and reconstruction from January 2015 to April 2020. Management of these patients involved culture-directed antibiotics, local wound debridement, various forms of reconstruction, and hardware removal when indicated. Ninety-four patients with 131 DBS-related procedures were included. Twelve patients (12.8%) had hardware extrusion, of which 6 occurred primarily at the scalp and 6 occurred primarily at the chest. Primary closure of scalp wounds (odds ratio, 0.05 [0.004-0.71], P = 0.035) was negatively associated with treatment success. The type of reconstruction of chest wounds did not affect its success ( P = 0.58); however, none of them involved a new surgical bed, such as contralateral or hypochondrial placement. Hardware extrusion is a significant complication of DBS-related surgery. Management of extrusion at the scalp should involve the use of tension-free, well-vascularized locoregional flaps as opposed to primary closure. Implantable pulse generator extrusions at the chest can be managed with both primary closure and repositioning in a new surgical bed. Extruded DBS implants may be salvaged with appropriate reconstructive considerations, and the authors suggest an evidence-based treatment algorithm.

An antibiotic envelope to reduce infections in deep brain stimulation surgery

The therapeutic benefits of Deep Brain Stimulation (DBS) surgery in patients with movement disorderssuch as Parkinson’s Diseaseare life-altering. Surgical site infections (SSI), however, can result in increasedhospitalisations, prolonged antibiotics and neurological sequelae. We performed aretrospective review to evaluate the effectiveness of an antibiotic envelope to reduce SSI in DBS surgeries.This study includedall DBS surgeries performed between August 2020 to May 2022 using a single-use, multifilament, antibiotic-coated mesh envelope wrapped around the DBS implantable pulse generator (IPG)(TYRX™ Absorbable Antibacterial Envelope,Medtronic Fridley, MN, USA). Standardised infection-prevention measures were applied and various patient-specific and surgery-specific factors were analysed.44 patients were analysed with 26 (59.1 %) primary implantations and 18 (40.9 %) revision surgeries.The median age was 65 years old with an average follow-up of 13.5 months (range 3–24 months). The mean Body Mass Indexwas 24.0 (range 16.7–35.6). 8 (18.2 %) patients had underlying diabetes mellitus. There were only 2 (4.5 %) SSIs reported with neither involvingthe subcutaneous IPG and antibiotic envelope. 1 superficial-incisional SSI (2.3 %) was from a prior retro-auricular abscess around a lead-wirerequiring antibiotics and subcutaneous implanttransposition. The other was a deep-incisional SSI (2.3 %) from repetitive trauma causingdelayed scalp wound dehiscence and lead-wire extrusion, requiring antibiotics and wound revision. Both subjects were discharged well with no implants removed. Theantibioticenvelope therefore appears to be a safe and well-tolerated adjunct that may reduce SSIs in DBS surgery. Further prospective work withlarger sample sizes in a multi-institution setting is required.

Geometric Design and Outcome of Transposition Flaps for Scalp Reconstruction

Background: The scalp is a unique part of the human body and various etiological factors, such as tumor extirpation, avulsion, infection, burns, or trauma, can lead to scalp defects. Primary closure, skin grafting, local flaps, tissue expansion or free tissue transfer is modalities available for scalp reconstruction. Local flap coverage is best option for full thickness loss with exposed bone. Among various local flap transposition flap is reasonable and flexible option with good outcome for scalp reconstruction.
 Objective: The purpose of this study was to evaluate the geometric design of transposition flap for scalp reconstruction concerning the dimension of the defect and outcome the surgery.
 Methods: This was a prospective observational study, conducted in the Burn & Plastic Surgery department of Rangpur medical college hospital, Rangpur and different private hospitals of Rangpur city over a period of three years from June 2018 to July 2021 through purposive sampling. All aged patients having single full thickness scalp wound with loss of pericranium were included in this study. In all cases transposition flaps were used. All the flaps were elevated through sub galeal lose areolar plane. Flap donor site was covered with split thickness skin graft taken from thigh. Surgical technique, patient factors and outcome were evaluated.
 Results: A total 50 patients were operated. The age range was 07-68 years, among them 36% patient were in the age range of 21 – 30 years. 80% patients in this series were male. In this series 64 % patients were construction and electric worker by profession. Electric burn was the main (64%) cause of soft tissue defect of scalp. The majority (46%) of the patients had a wound dimension of 51-70 cm2, smallest was (5x6) = 30cm2 and largest was (9x15) = 135cm2, indicating that extent of soft tissue defects in this series is quite extensive. 12 (24%) patients had complication and all were due to infection, seven patients had infection in flap recipient site, 2 patients had infection in flap donor site and 3 patients developed infection in skin donor site. There was no flap loss in our study.
 Conclusion: Sound knowledge of flap geometry and clear evaluation of the defect is mandatory for successful reconstruction of scalp defect. A local transposition flap with donor site skin grafting is reliable option for reconstruction of full thickness scalp defect in most instances.
 J Rang Med Col. September 2022; Vol. 7, No. 2:52-57

BACITRACIN ANAPHYLAXIS WITH MUCOSAL BUT NOT CUTANEOUS EXPOSURE

<h3>Introduction</h3> Evaluation of anaphylaxis involves obtaining a detailed history of medications and potential patient exposures, as well as documenting medications a patient currently tolerates. The route of administration of specific medications can sometimes be overlooked. <h3>Case Description</h3> A 58 year-old woman experienced an acute anaphylactic reaction consisting of cough, dyspnea, abdominal pain, and hypotension with systolic BP in the 80's, occurring 30 minutes after an outpatient surgery for scalp cyst removal. Peri-event tryptase was 30 ug/L and baseline tryptase was 6 ug/L. She had negative skin testing to latex and all local anesthetics used during the procedure. She subsequently had two additional episodes of anaphylaxis at home requiring self-administration of epinephrine and ER evaluation, but no clear inciting cause was identified. She was diagnosed with idiopathic anaphylaxis and started on H1 and H2 blockers, Montelukast, and Doxepin with no recurrence of symptoms. Further history revealed topical Neomycin/polymyxin B/Bacitracin ointment was applied to the scalp wound after cyst removal, and self-applied to the rectal mucosa due to diarrhea with both later episodes. She tolerated applying the ointment to intact skin. Skin testing was positive to bacitracin zinc and Polysporin (bacitracin + polymyxin); testing to neomycin and to polymyxin B sulfate alone were negative. <h3>Discussion</h3> Testing to bacitracin is indicated in peri operative anaphylaxis evaluation. In this case, anaphylactic reactions occurred when this was applied to incision wounds and mucosal surfaces which presumably increase systemic absorption. Bacitracin should be ruled out as a cause of peri operative anaphylaxis even with tolerance of topical bacitracin.

Successful management of depression skull fracture in a boy with dog bite injury

Rationale: There are many cases of daily reported dog bite injuries around the world. However, craniofacial fractures owing to dog bites are quite rare. They are frequently seen in the pediatric age group. Here, we report the successful management of a pediatric patient with depression skull fracture due to a dog bite injury. Patient’s concerns: A 3-year-old boy was admitted to the emergency department with a complicated skull fracture due to a dog bite injury. In physical examination, the patient was neurologically intact. He had hemorrhagic scalp wounds. Cerebrospinal fluid was leaking on the right temporal and frontal sides. Diagnosis: Cranial computed tomography revealed pneumocephalus, brain edema, and compound fracture associated with right frontal concussion. Intervention: After decompressive craniectomy, duraplasty was performed by placing a galea graft. Depressed fractures were removed and subdural bleeding control was provided. Outcomes: Perioperative and postoperative periods were uneventful. Lessons: Emergency medicine physicians should control possible underlying fracture lines in pediatric head trauma caused by dog bites.

Mild Head Injury: Criteria for Computed Tomography Scan

Background/Objective: Mild Head Injury (MHI) is the most commontype of head trauma, and forms a majority of the injuries seen in the traumaunit (65-85%).1 This study was aimed at using previously identifiedclinical risk factors to determine which category of patients with MHIwould not need to undergo Computed Tomography (CT). This may serveas cost saving measure to patients and hospitals likewise reduce collectiveradiation dose to the population.Methodology: A retrospective study conducted at the trauma unit of ateaching hospital situated in the Cape Metropole. CT scan images of 50patients aged 14 years and above who had MHI and undergone CTexamination were retrieved from the archive. Patients’ information, clinicalhistory and resultant CT findings were collated. Clinical risk factors werecorrelated with abnormal and normal CT scan findings. Data wereanalyzed using chi-square statistic at 95% confidence interval.Results: Twenty three (46%) of the patients had abnormal CT findings,and all presented with one or more of these risk factors; severe headache(10%), skull fracture (20%), scalp injury (6%), loss of consciousness(LOC)(8%) and intoxication(2%). The results were not statisticallysignificant when compared with the normal CT scans group. Four patients(8%) with no risk factors had normal CT scans. All the patients presentingwith the clinical risk factors, of nausea and vomiting 6% (n=50), seizures4% (n=50) had normal CT scan findings.Conclusion: Certain clinical risk factors can be used to suggest theprobability of abnormal CT scan in patients with MHI. Patients with norisk factors such as patients with confusion and disorientation are morelikely to have normal CT findings and may therefore be exempted from CTexamination. Further studies with larger sample size may be helpful invalidating these findings.

Microvascular Reconstruction of the Anterior Skull Base.

Anterior skull base defects present a unique reconstructive challenge. Risk factors such as previous operation, radiation and infection require a multidisciplinary approach to create a stable wound. Reconstructive microsurgery serves an important role when attempts with pericranial flap placement and nonvascularized graft obliteration fail. Our series analyzes the outcomes of 5 patients who underwent vascularized reconstruction of craniofacial defects at Northwestern Memorial Hospital from 2014-2021. Each patient presented with a complex, hostile scalp and bony wound. Common risk factors included previous craniotomy, failed obliteration, chemoradiation, osteomyelitis and epidural abscess. Patients underwent multi-stage procedures to obtain wound source control, reconstruct the frontal sinus and skull base, and frontal bone cranioplasty. Each patient underwent successful free flap reconstruction without flap loss or donor site complications. No patients suffered ongoing symptomatic CSF leak or pneumocephalus. However, only two patients have had sustained success with their alloplastic cranioplasty. A perfect, watertight seal is required to prevent seeding the implant and avoiding infection. Overall, free flap reconstruction of the skull base and frontal sinus is a necessary solution when patients fail more conservative locoregional options. Close collaboration with neurosurgery can help with diagnosis and establish the optimal timing for surgical care.

Honey combined with silver ion dressing in complicated chronic wound of the scalp: a case report.

Scalp wound healing is a complex process. Nonhealing wounds can become chronic wounds, which increase the trauma and economic burden on a patient and may even cause death in severe cases. Thus, it can be difficult to find an effective treatment for chronic wounds of the scalp. We present a case of a 13-year-old female patient with a chronic wound caused by a scalp incision infection 3 months after two operations for craniotomy for arachnoid cyst resection and cystic lesion-cisterna magna drainage. After repeated dressing changes and two debridement operations, the incision had still not healed during the following year. The wound finally healed after 6 months of dressing changes by combining honey with silver ion dressings, and the incision had not re-ruptured after 10 months of follow-up. Honey combined with silver may be an effective method for the treatment of chronic scalp wounds.

An Algorithm for Reconstruction of Electrical Injuries of the Scalp.

Electrical injuries of the scalp are a frequent occurrence in developing countries. Burns can be contact or conductive and result in extensive tissue damage. The authors present their experience with treatment of scalp and calvarial electrical injuries and propose a management algorithm. This was a retrospective cohort study comprising all patients with electrical injuries of the scalp treated at the authors' center between January of 2010 and December of 2016. Noncontrast computed tomography scans were obtained to assess viability of the calvarium in patients who presented more than 2 weeks after injury. Single-stage débridement and reconstruction were performed. All nonviable soft tissue and bone was removed. Soft-tissue reconstruction was performed with skin grafts, local scalp flaps, pedicled trapezius flaps, and free flaps (anterolateral thigh, latissimus dorsi, and scapular). Cranioplasty was performed in a delayed manner with autologous bone grafts. Over a 7-year period, a total of 52 patients underwent scalp reconstruction for high-voltage (44 patients) and low-voltage (eight patients) electrical injury. All patients underwent successful soft-tissue reconstruction. Osteomyelitis with draining sinuses developed in three patients; these patients underwent flap re-elevation and bone débridement, which resulted in a healed wound and stable reconstruction. Cranioplasty was performed with split calvarial grafts in two patients and split rib grafts in four patients. One patient underwent scalp tissue expansion for hair restoration. The authors propose an algorithm for reconstruction of electrical injuries of the scalp. Thorough débridement of the calvarium is the most important determinant of a successful outcome. Therapeutic, IV.

A tactics for treating large skin wounds on the head

An open wound on the head is an injury (skin tear) of all scalp external layers including dermis, subcutaneous fatty tissue, aponeurosis, muscles, vessels and nerves with intact skull bones and intact neurological reactions [1].Extensive wounds of the external head layers, in addition to a standard threat to the human health, bear an additional risk due to their close localization to the brain. Because of the abundant blood supply to scalp soft tissues, high rate of volumetric blood flow (50–60 milliliters per 100 g of brain tissue), numerous extra-, intracranial arterial and venous anastomoses, there is a real danger of spreading the infection inside the skull and developing meningitis or encephalitis.Problems of care of patients with extensive head wounds, risk of complications that can cause severe consequences determine the relevance of the issue presented in this work.Objective. To analyze treatment results of patients admitted to the emergency department of Mariinskaya State City Hospital in St. Petersburg within three months in 2021 and to develop an optimal tactics for treating patients with extensive wounds of the scalp.Material and research methods. 2245 patients with various types of head injury were admitted to the hospital; 610 (27.2 %) of them had damage of the external scalp layers. Each patient had standard clinical and laboratory examination and multislice computed tomography (MSCT) examination of the head at 64-slice Definition AS (Siemens, Germany) CT scanner. In the emergency department, all patients who were injured by high-energy traumatic objects had the primary surgical debridement; all patients who were injured by low-energy traumatic objects had wound toilet and wound suturing. Three most representative cases with extensive wounds of the external scalp (over 10 cm) with illustrations are presented in the article as clinical examples.Results. All patients had good outcomes. There were no any signs of wound infection either.Conclusion. A thorough primary surgical debridement of scalp wounds with their drainage followed by observation and treatment in the hospital is a necessary condition for successful healing of large scalp wounds.

Surgical Treatment of Radiation-Induced Late-Onset Scalp Wound in Patients Who Underwent Brain Tumor Surgery: Lessons from a Case Series.

Objective The management of late-onset scalp wounds following irradiation is troublesome, especially in patients with a surgical history of intracranial neoplasms. It, insidiously, starts with wound dehiscence or discharge and never heals spontaneously without appropriate surgical treatment. Nevertheless, definite treatment guidelines have not yet been established. Here, we present our clinical experience with radiation-induced scalp wounds and suggest a surgical principle for their treatment. Patients and Methods. The medical records of 13 patients with brain tumors, who were treated for intractable scalp wounds after irradiation between January 2000 and August 2015, were retrospectively reviewed. All the patients underwent a craniotomy for brain tumor resection. Surgical treatment for a late-onset scalp wound was decided based on the “reconstructive ladder” and according to the status of bone flap and scalp tissue. The patients' clinical characteristics and information regarding irradiation, surgery, and postoperative complications were recorded. Results Scalp wounds developed 4.4 years, on average, after the completion of irradiation. Revision operations were performed an average of 2.3 times, and 6 patients (46%) required more than 2 operations. The bone flap was removed in 11 patients (84.6%) to achieve complete wound healing. Among them, 3 patients underwent a cranioplasty using artificial materials, but 2 patients underwent removal due to recurrent wound problems. Conclusions Postirradiation scalp wounds are difficult to treat and have a high risk of recurrence. If osteoradionecrosis is suspected, the bone flap should be removed. It is important to debride unhealthy tissues aggressively and cover defects with robust tissue.