REVIVING CRANIAL OUTER TABLE PERFORATIONS AS A MODERN INNOVATION FOR COMPLEX SCALP AVULSION INJURIES RECONSTRUCTION: A CASE REPORT

Authors

  • Boro Dzonov University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia https://orcid.org/0000-0002-9747-7627
  • Elizabeta Zjogovska Mircevska University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
  • Sofija Pejkova University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia https://orcid.org/0000-0002-6833-7078
  • Robert Sumkovski University Clinic of Neurosurgery, Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of North Macedonia https://orcid.org/0000-0001-7276-9212
  • Margarita Peneva University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
  • Gordana Georgieva University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia https://orcid.org/0000-0001-7779-5647
  • Blagoja Srbov University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia https://orcid.org/0000-0001-8602-6313
  • Sara Hadjitrifon University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
  • Darko Aleksovski University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia https://orcid.org/0009-0002-8075-1586
  • Renata Kochoska University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
  • Ermira Hamzai University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
  • Lena Kakasheva Mazhenkovska Institute of Histology and Embryology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Republic of North Macedonia https://orcid.org/0000-0002-9807-2277

Keywords:

scalp avulsion injuries, reconstruction, transcortical holes in the outer table of the cranium, skin grafts, wound healing, reconstructive ladder

Abstract

Introduction: Scalp avulsion injuries can present a tremendous challenge for both the patient and the surgeon. The absence of periosteum can limit the reconstruction options. Various surgical techniques are available for scalp reconstruction, including skin grafting, microsurgical scalp replantation or free flaps. A cranial outer table perforation is also a potential treatment since we activate the body’s natural healing processes and within a matter of days the defect is gradually repairing with granulation tissue on which we can use skin grafts for further reconstruction.

Case Report: A 52-year-old patient was brought at our emergency center, due to an injury that occurred as a result of hair entrapment in high-speed rotatory devices, such as agricultural machine. Since the patient refused a potential treatment using free flaps, and microsurgical scalp replantation was not possible due to the condition of the avulsed scalp segment, we made transcortical holes in the outer table of the cranium up to the level of diploe for reconstruction of this defect.

Discussion: For individuals with scalp defects as a result to a trauma, a carefully planned multidisciplinary approach is required. It is crucial to have a comprehensive understanding of scalp anatomy, wound healing principles and physiology. Every reconstructive option should be taken into consideration.

Conclusion: Despite the significant advancements made in the reconstructive field, we are often faced with situations where we have to rely on a valuable historical medical technique. The modern reintroduction of cranial outer table perforations offers a bold, yet practical solution.

References

Furlanetti LL, de Oliveira RS, Santos MV, Farina JA Jr, Machado HR. Multiple cranial burr holes as an alternative treatment for total scalp avulsion. Childs Nerv Syst 2010; 26: 745-749. doi: 10.1007/s00381-010-1145-7.

Sokoya M, Misch E, Vincent A, Wang W, Kadakia S, Ducic Y, et al. Free Tissue Reconstruction of the Scalp. Semin Plast Surg 2019; 33(1): 67-71. doi: 10.1055/s-0039-1678470.

Calderoni DR, Rosim ET & Kharmandayan P. Successful calvarial bone salvage using multiple outer table perforation technique on total scalp avulsion injury. Eur J Plast Surg 2013; 36(1): 49-53.

Hu X, Ohnmeiss DD, Lieberman IH. Use of an ultrasonic osteotome device in spine surgery: experience from the first 128 patients. Eur Spine J 2013; 22(12): 2845-2849. doi: 10.1007/s00586-013-2780-y.

Sabel M, Stummer W. The use of local agents: Surgicel and Surgifoam. Eur Spine J 2004; 13 (Suppl 1): S97-S101. doi: 10.1007/s00586-004-0735-z.

Lo Schiavo A, Ruocco E, Russo T, & Brancaccio G. Locus minoris resistentiae: An old but still valid way of thinking in medicine. Clinics in dermatology 2014; 32(5): 553-556. https://doi.org/10.1016/j.clindermatol.2014.04.001.

Angel DE, Lloyd P, Carville K, & Santamaria N. The clinical efficacy of two semi-quantitative wound-swabbing techniques in identifying the causative organism(s) in infected cutaneous wounds. International wound journal 2011; 8(2): 176-185. doi: 10.1111/j.1742-481X.2010.00765.x.

Germann AM, Jamal Z, Al Khalili Y. Anatomy, Head and Neck, Scalp Veins. p. 1-11 Updated 2023 Jan 13. PMID: 31082005.

Simman R. Wound closure and the reconstructive ladder in plastic surgery. J Am Col Certif Wound Spec 2009; 1(1): 6-11. doi:10.1016/j.jcws.2008.10.003.

Deng K, Xiao H, Wang H, Xu X. Latissimus Dorsi Muscle Flap for Scalp Reconstruction and Postoperative Ulceration Management. Journal of Craniofacial Surgery 2022; 33(3): e233-e236. doi: 10.1097/SCS.0000000000007997.

Lamaris GA, Knackstedt R, Couto RA, Abedi N, Durand P, Gastman B. The Anterolateral Thigh Flap as the Flap of Choice for Scalp Reconstruction. J Craniofac Surg 2017; 28(2): 472-476. doi:10.1097/SCS.0000000000003404.

Wong CH, Wei FC. Anterolateral thigh flap. Head Neck 2010; 32(4): 529-540. doi: 10.1002/hed.21204.

Chana JS, & Wei FC. A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. British journal of plastic surgery 2004; 57(7): 603-609. doi: doi: 10.1016/j.bjps.2004.05.032.

Shimizu F, Oatari M, Matsuda K, Uehara M, Sato S, & Kato A. Algorithm for reconstruction of composite cranial defects using the fascial component of free anterolateral thigh flaps. The Journal of craniofacial surgery 2013; 24(5): 1631-1635. doi: 10.1097/SCS.0b013e3182999a33.

Markey JD, Seth R, Wang SJ, Ryan WR, El-Sayed IH, Knott PD. Anterolateral Thigh Adipofascial Flap: A New Option for Scalp Reconstruction. J Reconstr Microsurg 2016; 32(2): 160-163. doi:10.1055/s-0035-1558989.

Jiang Z, Li S, Cao W. “Emergency management of traumatic total scalp avulsion with microsurgical replantation”. Ulusal travma ve acil cerrahi derg 2014; 20(1): 66-70. doi: 10.5505/tjtes.2014.68253.

Adams DC, & Ramsey ML. Grafts in dermatologic surgery: review and update on full-and split-thickness skin grafts, free cartilage grafts, and composite grafts. Dermatol surg 2005; 31(8 Pt 2): 1055-1067. doi: 10.1111/j.1524-4725.2005.31831.

Downloads

Published

2023-12-27

Issue

Vol. 3 No. 3 (2023): Acad Med J

Section

Case Reports