Management of Dead Skull Bone Following Electrical Injury-A Case Reoprt

據報告約有百分之三十的頭皮深部燒燙傷會傷及顱骨。由於這類的傷害可能傷及顱骨，所以處理上也產生令人棘手的問題。依據處理創傷的外科準則，所有壞死的軟組織甚至骨頭都必須清除，所以傳統對於此類頭皮及顱骨傷口的治療是以手術清除包括顱骨的所有壞死組織，或以抗生素照護傷口等其壞死組織慢慢剝落後再進行重建。然而這樣的治療方法常會導致許多潛在危險包括：腦膜外或顱內感染、腦脊髓液外漏、腦部赫尼亞（脫出）等等，另外住院日期的延長以及患者康復後因顱骨缺損導致頭部外形內凹的不美觀結果，也都是採用前述傳統治療的缺點。有些研究報告指出，處理這種情況時，並不須要清除所有壞死的骨頭。僅須對壞死顱骨的表層做清創，保留能維持顱骨外形及有保護作用的壞死骨頭，然後再覆蓋以血循豐富之皮瓣做重建即可。這些壞死的骨頭會漸漸被新生的骨頭所取代。我們報告一個因三萬三千伏特高壓電燒傷後造成顱骨壞死區域的病例，在不清除全部壞顱骨的情形下，早期清創及以旁肩胛自由皮瓣覆蓋患處來重建；在與傳統完全清除死骨後再進行重建的手術比較下，此法得使病人可較早出院且較少如上述之嚴重併發症。在術後八個月後的探查手術時，我們發現大塊的壞死顱骨，在血循豐富的皮瓣下已漸漸變小變薄，將之取出後可見其下顱骨的表面有多處分散的出血點，由此可見其已是健康的骨頭。本例證明早期皮瓣覆蓋的處理能提供正面的結果且最後亦有不錯的外觀。

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並列摘要

Skull involvement has been reported in 30℅ of deep scalp burns. They may result in devitalization of the skull bone which can poses difficult problems in management. According to surgical principle that all of the necrotic soft tissues and the dead bones should be excised, classical reconstruction of the scalp and skull 15 performed after thorough debridement or sequestration of the necrotic bone, However, they induced many potential disadvantages including epidural or intracerebral infections, leakage of spinal-cerebral fluids (CSF), and herniation of the brain , not to mention of the prolonged hospital stay and poor aesthetical contour due to bony defect concavity . Some studies claimed that there 15 no need to remove all of the dead bones. Do just debridement or remove only partial of the bones and leave the dead skull bone along, which can provide protection to the brain and maintain the contour of calvaria, then covered them with well vascularized nap. The articles claimed that the dead bone will be replaced by regenerated bone gradually. We presented a case who received early free parascapular flap reconstruction on a nonviable skull bone resulted from 33000 volts electrical insult without excised the dead bone. Patient discharged at 4lst day after admission. It 15 much earlier compared to those cases managed by reconstruction after aggressive debridement of all dead bone. We have a chance to explore the flap due to a discharge sinus eight months later and the volume of the dead bone covered by well vascularized flap were gradually reduced, our case showed us a positive point of view of early flap coverage without removal of all dead skull bone in dealing with this kind of patients.

並列關鍵字

electric burn ； skull bone necrosis ； vascularized flap ； parascapular flap ； free flap

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Management of Dead Skull Bone Following Electrical Injury-A Case Reoprt

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