Scalp injury management by a maxillofacial surgeon in a low-resource hospital

Background Head or scalp injury is a life-threatening and typically accidental human injury. Most medical departments require immediate medical treatment and proper treatment with specialized medical personnel and facilities. However, in low-resource environments, such as the rural region of West Africa, the authors have treated emergency trauma patients and provided immediate treatment despite lack of resources. Case presentation We reviewed three cases of scalp injury patients, with representative clinical information, and used these cases to outline feedback on scalp trauma treatment based on the specialty knowledge of general and emergency surgeon. Conclusions Oral and maxillofacial surgeons are medical specialists that can immediately diagnose and treat these scalp injuries based on their medical knowledge and experience with the maxillofacial region.

Massive Dog Bite Injury of the Scalp in One-year Old Boy

A one-year-old boy was referred to our Department of Pediatric Surgery with extensive scalp injury. He was bitten by a neighbour’s mixed-breed dog. The wound of the forehead is primary closed while scalp is reimplanted. Due to non-acceptance on the eighth day a necrectomy of devitalized tissue was done. Before applying Integra®, for 2 days, the wound was treated with a V.A.C.® system. After 14 days, Integra® was accepted and split-thickness skin graft (STSG) was transplanted from left upper leg. After 3 months the local status is satisfactory. A hair transplant is planned in the future.

Semirigid cervical spine collar and risk of missing significant soft tissue injuries

We report the case of an initial misdiagnosis of significant scalp soft tissue hidden beneath a semirigid cervical collar. A 16-year-old unrestrained rear seat passenger was involved in an RTA sustaining a subdural haematoma, cervical spine fractures and what was initially diagnosed as a significant degloving scalp injury. The patient was admitted to the intensive care unit intubated sedated, and with a cervical collar. The scalp injury was dressed with a view that potential reconstructive surgery would be needed subsequently.This case demonstrates that while cervical collars remain a fundamental aspect of initial prehospital care in trauma, they have potential drawbacks to their use, which need to be carefully noted. Some of these drawbacks have been reported extensively in the literature. This case outlines the necessity of a thorough secondary survey in the trauma patient as the cervical collar can obscure the assessment of significant head and neck soft tissue injuries.

Intracranial infection caused by minor skin contusion associated with previous craniotomy

Minor damage to the scalp may lead to intracranial infection. Moreover, the postoperative state of the scalp, skull and meninges is especially noteworthy with respect to invasion of pathogens into the skull. Therefore, a detailed medical history should be obtained from patients with even minor scalp injuries to avoid intracranial infection. We herein report a case of intracranial infection caused by a minor scalp injury associated with previous craniotomy, which was missed at first.

DEPRESSED SKULL FRACTURE

Purpose of the study: The purpose of study was to interrelate CT findings of depressed skull fracture with clinical findings. Study design: This was exploratory study. Place of study: The study was conducted at Mayo Hospital Lahore and Lahore General Hospital. Duration of study: From March 9, 2004 to October 2004. Sample size: Fifty patients irrespective of their age and sex were included. Patients selection: Only the newly admitted patients in the above mentioned hospitals were included in the study. Previously diagnosed depressed skull fracture or the patients having associated facial abdominal and thoracic injuries were excluded. Methodology: Patients having depressed skull fracture were clinically evaluated and thereafter subjected to 4th generation spiral CT scan at the radiology Department of the above mentionedhospitals. Both bone and brain window were taken for various intracranial structures. Results: Analysis of the data for association between the variables of clinical and CT findings revealed that patients with conscious level, with DSF and having mild head injury were less associated with scalp injury (p=0.1156) which is statistically insignificant. DSF with moderate and severe head injury had more probability of scalp injuries. Scalp laceration seen with DSF had association with scalp injury (p<0.001). Conclusion: It is a key for clinician and neurosurgeon to use GCS score in congestion with the CT findings for early management of DSF.