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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 56-58

Reconstruction of scalp defects in electrical burns: Challenges and options


Department of Plastic and Reconstructive Surgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

Date of Submission11-Dec-2020
Date of Acceptance05-Jan-2021
Date of Web Publication29-Jun-2021

Correspondence Address:
P V Sudhakar
Department of Plastic and Reconstructive Surgery, Andhra Medical College, Visakhapatnam - 530 002, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jhnps.jhnps_63_20

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  Abstract 


Introduction: Electrical burn injury in India comprises a fair percentage of overall burn injuries, and they cause significant morbidity. Reconstruction of scalp defects often poses challenges to the plastic surgeon regarding the timing of surgery, choice of reconstruction, and postoperative management. The objective of this article is to throw light on various options for reconstruction of scalp defects as the involvement leads to significant morbidity. Materials and Methods: The study was conducted at a tertiary burn care unit. The period of this study was from 2016 to 2019. Retrospective analysis was done. Results: In this study, retrospective analysis of 40 cases of scalp burns was evaluated from 2016 to 2019. Out of these, 6 patients were managed with primary suturing, 8 patients underwent split-thickness skin graft, 24 patients required local flaps, and 2 patients were managed with extracorporeal radial forearm flap. There were no major complications. Minor complications like wound infection were seen in five of the local flap patients which were managed with antibiotics and regular dressing. Two patients had partial flap loss which was revised and managed conservatively. All flaps healed well. There was hair loss patch evident in patients where split-thickness graft was used. Conclusion: Thorough debridement of the wound is necessary in electrical burns. Smaller scalp wounds can be managed with split-thickness skin graft and local flaps, but larger defects should be managed with distant flaps and free flaps. This study shows that local flaps are the ideal choice for reconstruction of scalp defects due to their easy availability, minimal complications, and acceptable cosmesis.

Keywords: Electrical burns, local flaps, scalp defects


How to cite this article:
Aithal K, Jena UK, Vasireddy S, Muddada S, Sudhakar P V. Reconstruction of scalp defects in electrical burns: Challenges and options. J Head Neck Physicians Surg 2021;9:56-8

How to cite this URL:
Aithal K, Jena UK, Vasireddy S, Muddada S, Sudhakar P V. Reconstruction of scalp defects in electrical burns: Challenges and options. J Head Neck Physicians Surg [serial online] 2021 [cited 2021 Dec 2];9:56-8. Available from: https://www.jhnps.org/text.asp?2021/9/1/56/319748




  Introduction Top


Involvement of scalp in electrical burns is around 3%–5%.[1] There are challenges in managing the scalp burns in case of electrical burns with regard to need for split-thickness skin graft or flap, choice of flap, role of debridement of bone, timing of management, and reconstructive method to be adopted.[2] It poses a special problem in the form of inelastic nature of the scalp and also hairy nature of the scalp. Exposure of the calvarium necessitates the requirement of a vascularized flap. With proper choice of management, various complications can be prevented along with cosmetic disfigurement.


  Materials and Methods Top


This study was conducted from 2016 to 2019. It was a retrospective analysis of the cases of electrical burn involving scalp in a tertiary care center. There were 40 cases of scalp burns admitted during this period.


  Results Top


Among 40 cases, primary suturing was done in 6 cases, split-thickness skin graft was done in 8 patients, extracorporeal radial forearm flap was done in 2 patients, and 24 patients were managed by local flaps. There were 28 male patients and 12 female patients. Among the local flaps, the most common flap was the transposition flap which was done in 12 patients followed by double rotation flap, which was done in 7 patients. Other flaps being the trapezius myocutaneous flap in two patients and pinwheel flap in three patients.


  Discussion Top


The most common cause of deep scalp burns is electrical burns, and the severity of the burns is mainly determined by the duration of contact with the electrical source, voltage of the current, and also by the resistance offered by the body structure in contact.[3],[4] It is inversely proportional to the diameter of the body structure. High resistance is provided by calvarium, so electrical burns commonly involve the scalp.[5],[6]

Various options for reconstruction of scalp burns include:

  • Primary suturing
  • Split-thickness skin graft
  • Local flaps
  • Regional flaps
  • Free flaps.


Early debridement and coverage of the defect provides the best results.[7] However, if there is exposure of the calvarium, vascularized tissue coverage provides better results and lesser complications.[8] Debridement of the necrotic bone is one of the important components in the management of the scalp burns.

Skin grafts are unstable most of the times. They lead to repeated breakdown of the wound, poor wound healing, and unacceptable esthetic appearance.[9]

Local flaps [Figure 1] were the best options for reconstruction of medium-sized defects as the principle of “replace like with like” would be followed, operative time was less, postoperative monitoring was easier, and postoperative complications were minimal.[10]
Figure 1: Different locoregional flaps used in scalp reconstruction

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Among the local flaps, transposition flap and the double rotation flaps were the commonly used flaps for reconstruction. Transposition flaps [Figure 4] and [Figure 5] were simpler, less time consuming, and minimal donor site morbidity, but disadvantage was that the donor area had to be covered with split-thickness skin graft which would give rise to unpleasant esthetic appearance.[9] Double rotation and pinwheel flap [Figure 2] and [Figure 3] could be used for better esthetic results, but the disadvantage is that it cannot be used for larger scalp defects. Trapezius myocutaneous flap and extracorporeal radial forearm flap are the other options which can also be used for defects involving the scalp region.[11],[12]
Figure 2: Pin wheel flap

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Figure 3: Double rotation flap

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Figure 4: Transposition flap

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Figure 5: Transposition flap

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There were no systemic or any major complications. Minor complications like wound infection were seen in five of the local flap patients which were managed with antibiotics and regular dressing. Two patients had partial flap loss which was revised and managed conservatively.

All flaps healed well. There was hair loss patch evident in patients where split-thickness graft was used.


  Conclusion Top


Reconstruction of the scalp burn defects should be done according to the reconstructive ladder. Early debridement of the wound with vascularized tissue coverage provides excellent healing. Local flaps, mainly transposition flaps, most often are the ideal choice for reconstruction of scalp defects due to their easy availability, minimal complications, and acceptable cosmesis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Disclosure

This material has never been published and is not currently under evaluation in any other peer reviewed publication.

Ethical approval

The permission was taken from Institutional Ethics Committee prior to starting the project. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.



 
  References Top

1.
Hettiaratchy S, Dziewulski P. ABC of burns: Pathophysiology and types of burns. BMJ 2004;328:1427-9.  Back to cited text no. 1
    
2.
Victor J, Shetty N, Manickavachakan N, Dinakara D. An algorithmic approach to reconstruction of complex scalp defects in electric burns. Indian J Burns 2017;25:44-51.  Back to cited text no. 2
  [Full text]  
3.
Srivastava JL, Biswas G, Narayan RP, Goel A. Chronically exposed calvarium following electrical burns. Burns 1993;19:138-41.  Back to cited text no. 3
    
4.
Sarangal A, Goil P, Srivastava S. Delayed reconstruction with free flap: Answer to postelectric burn complex wounds: A 3-year experience. Indian J Burns 2015;23:32-6.  Back to cited text no. 4
  [Full text]  
5.
Haddad SY. Electrical burn - a four-year study. Ann Burns Fire Disasters 2008;21:78-80.  Back to cited text no. 5
    
6.
Gümüğ N, Coban YK, Reyhan M. Cranial bone sequestration 3 years after electrical burn. Burns 2006;32:780-2.  Back to cited text no. 6
    
7.
Norkus T, Klebanovas J, Viksraitis S, Astrauskas T, Gelunas J, Rimkus R, et al. Deep electrical burns of the calvarium: Early or delayed reconstruction? Burns 1998;24:569-72.  Back to cited text no. 7
    
8.
Spies M, McCauley RL, Mudge BP, Herndon DN. Management of acute calvarial burns in children. J Trauma 2003;54:765-9.  Back to cited text no. 8
    
9.
Rafaela E, Maria M, Pedro M, Ruben C. Reconstruction of post-electrical burn scalp defect with exposed bone: A case report. Surg Case Rep 2020;2:1-3. [Doi: 10.31487/j.JSCR.2020.02.09].  Back to cited text no. 9
    
10.
Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: An algorithmic approach. Plast Reconstr Surg 2005;116:54e-72e.  Back to cited text no. 10
    
11.
Kumar N, Paul K, Barreto E, Lamba S, Gupta A. Management of scalp defects due to high-voltage electrical burns: A case series and proposed algorithm to treat calvarium injury. Eur J Plast Surg 2016;39:29-36.  Back to cited text no. 11
    
12.
Jeyakumar P, Hussain AT, Ahamed AR. Reconstruction of extensive post-electric burn scalp defects with exposed bones: A study of 12 cases. Ann Plast Surg 2018;81:39-44.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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