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Complex Scalp and Calvarial Reconstruction in Burn Patients- The Neuroplastic Surgery Approach
Jude Kluemper, BS
Abdulaziz Elemosho, MD
Emily Pfahl, BS
Kerry-Ann Mitchell, MD PhD
The Ohio State University College of Medicine
2024-01-15
Presenter: Jude Kluemper
Affidavit:
I certify that the work presented here is the original work of Jude and members of the Mitchell lab. This work has not been presented at another major meeting.
Director Name: Gregory Pearson
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: Management of head and neck burns is challenging for a variety of reasons, including the multiple critical structures and specialized tissue types in this region. Here we present a novel algorithm for scalp and skull reconstruction in the burn patient based on the growing field of Neuroplastic Surgery. We performed a systematic literature review and utilize cases performed at our institution to highlight relevant principles.
Cases: The first patient was a 38 y.o. female involved in a house fire who sustained <5% total body surface area burns to her upper extremities, torso and approximately 50% of her scalp including the pericranium. The scalp and outer table of the calvaria were debrided. A synthetic dermal matrix was then overlayed to generate neodermis upon which a full thickness skin graft was placed.
The second patient was a 31 y.o. male who sustained an electrocution burn to the scalp. The wound was debrided and reconstruction was attempted in previous surgeries. He presented ~1 year after initial injury with a non-healing wound and a large scalp/calvarial defect. The scalp and skull were debrided via craniectomy. A rotational flap was used to provide coverage. Cranioplasty using an alloplastic implant was performed in a staged procedure after adequate healing.
Discussion: Reconstruction varies based on the extent of the scalp/calvarial injury. Full-thickness scalp burns require debridement of the outer table of the calvaria whereas full-thickness scalp and skull burns necessitate a craniectomy and alloplastic reconstruction. The unique characteristics of scalp tissue also limit reconstructive options.
