A missed scalp laceration causing avoidable sequelae

Abstract Background The use of cranial fixation devices in neurosurgery is very common, which is considered to be an important auxiliary method for many craniotomies. However, previous studies have reported complications of using cranial fixation devices, including brain tissue, nerve and blood vessel damage, scalp laceration, subcutaneous hematoma, etc. Some of the complications are serious and even potentially fatal, and the causes of which may be related to the incorrect use of cranial fixation devices. Although there are no serious complications in our review, the cause of that needs to be further summarized and analyzed, as so to minimize the serious consequences caused by the cranial fixation device slippage and ensure the safety of the patients’ surgical procedure. Case presentation In our recent work, we have continuously found three cases of unstable cranial fixation devices, which make us to analyze the possible factors and summarize experience combined with the review of other senior neurosurgeons (more than 3 years of working experience) from different departments of neurosurgery. Conclusions Based on our recent incidents of unstable cranial fixation and the experience of investigating and analyzing senior doctors from different neurosurgery centers, we summarized experience to minimize the risk of unstable cranial fixation. We tried a variety of options, including a safe anatomical location for cranial fixation, teamwork, and communication with anesthesiologists and itinerant nurses, to ensure the stability of the patient’s cranial fixation devices. The data obtained in this survey has great limitations, including the doctor’s personal prejudice and dependence on anecdotal memories. Therefore, the data should be interpreted with caution. However, there are still some modes that can help to better understand the use of safe cranial fixation. Based on the above research and analysis, we have made recommendations that may help neurosurgeons to avoid preventable complications

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Air embolism associated with wounds from a pin-type head-holder

Journal of Neurosurgery ◽

10.3171/jns.1982.57.5.0710 ◽

1982 ◽

Vol 57 (5) ◽

pp. 710-713 ◽

Cited By ~ 18

Author(s):

Dachling Pang

Keyword(s):

Posterior Fossa ◽

Air Embolism ◽

Posterior Fossa Surgery ◽

Sitting Position ◽

Entry Site ◽

Content Type ◽

Tension Pneumocephalus ◽

Head Holder ◽

Scalp Laceration ◽

Fine Print

✓ A case of intraoperative air embolism during posterior fossa surgery performed with the patient in the sitting position is reported. The entry site was through a comminuted fracture and scalp laceration resulting from faulty application of a pin-type head-holder. The possible role played by a large tension pneumocephalus in the ingress of venous air is also discussed. Simple precautions regarding the use of the pin-type head-holder are suggested to lessen the possibility of air embolism through the puncture wounds.

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Scalp Reconstruction among Neurotrauma Patients: Presentation, Management and Outcome- Single Center Study

Eastern Green Neurosurgery ◽

10.3126/egn.v2i2.29263 ◽

2020 ◽

Vol 2 (2) ◽

pp. 52-56

Author(s):

Dinesh Kumar Thapa

Keyword(s):

Traffic Accidents ◽

Burn Injury ◽

Road Traffic ◽

Surgical Techniques ◽

College Teaching ◽

Wound Management ◽

Split Thickness Skin Graft ◽

Physical Assault ◽

Cross Sectional ◽

Scalp Laceration

Background: Scalp laceration is common findings among patients with head injury. It may present with simple laceration, laceration with loss of tissue or degloving type of injury. This study was conducted to observe the different techniques or wound management and fate of thus reconstructed scalp lacerations. Methods and materials: This is a cross-sectional analytical study which was conducted in B&C Medical College Teaching Hospital, Jhapa, Nepal. Patients presented with major scalp lacerations needing repair in Operation Theatre between June 2017 to May 2019 were included. Age, gender, mode of injuries, severity of the injury, various types of management and complicationswere studied and thus collected data were analyzedin IBM SPSS version 23. Results: There were 53 cases of scalp injuries with male(75%) predominance and mean age of 31.51 (SD 15.218) yearsin this study. Road traffic accident was the major cause of injury 28(53%), followed by physical assault 16(30%), fall injury 7(13.2%) and burn injury 2(3.7%).Primary closure was possible in 29(54.7%), advancement flap in15(28.3%), flap rotation in 7(13.2%) and split thickness skin graft was in 2(3.8%) patients. Wound infection was seen among 6(11.3%) patients, wound break down in 2(3.7%) and flap failure with dehiscence was observed in 1(1.9%) patient needing secondary healing and closure. Conclusion: Scalp laceration is commonly seen in neurotrauma patients with or with-out intracranial injury. Road traffic accidents top the chart in our part of world.All kinds of scalp laceration can be managed well with different types of surgical techniques.

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