Emergency surgical treatment of a child with a traumatic brain injury and complete rejection of the scalp due to a bite (clinical case)

Abstract

Total separation of the scalp is a serious trauma in clinical practice. Common in adult women and rare in children. Among children, the most common cause of such injuries is animal bites, including dog bites. The article presents the experience of treating a two-year-old child who was admitted to the Regional Clinical Hospital No. 2 in Tyumen (Russia) with an extensive scalped wound of the scalp in combination with craniocerebral trauma, traumatic shock, multiple bitten wounds of the soft tissues of the head with a violation of the integrity of the upper lacrimal tubule. Immediately from the moment the child was transported by the ambulance team, anti-shock, antibacterial, decongestant, symptomatic therapy was started, primary surgical treatment of wounds was performed with restoration of the integrity of the upper lacrimal canal of the right eye. The child had no indications for neurosurgical intervention. The standard treatment for a detached scalp is, if possible, microsurgical replantation, but due to the impossibility of performing microsurgical replantation in this case (an infected wound, a skin flap was recognized as unviable by an interdisciplinary council), the defect was closed on a delayed basis with a fullthickness skin graft taking into account the blood supply and anatomical features bed. In this case, during the period of scalp plasty, there were no postoperative complications, the engraftment of autodermal grafts was satisfactory, and the healing of donor wounds was also satisfactory. The child was discharged for the outpatient follow-up stage after 3 months of inpatient treatment. In our opinion, the main reasons for achieving a good clinical result were an interdisciplinary approach to treatment, a combination of correctly performed primary surgical treatment of a wound, subsequent timely complex treatment in a specialized department, and a high regenerative potential of the child. In our opinion, the choice of the method of reconstructive intervention in patients with soft tissue and soft tissue bone defects of the scalp requires a differentiated approach, taking into account the etiology of the defect, its anatomical features and the possibility of compensating for aesthetic disorders. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: children, traumatic brain injury, scalp wound, scalp avulsion, treatment.