High-Voltage Electrically Head Injury Presenting underlying Calvarial Osteomyelitis: Single Indonesian Tertiary Hospital Experience

Abstract

Objective: To demonstrate the characteristic of high-voltage electrically head injury patients presenting underlying calvarial osteomyelitis. Methods: Retrospectively report of patients high-voltage electrically head injured with calvarial osteomyelitis from January 1 st 2011 to December 31 st 2013. The demographic variable namely age, sex, place of accident, present of calvarial osteomyelitis, Glasgow coma scale, surgical treatment type, grading of burn injury and total body surface area of burn (TBSA). Results: Eleven high-voltage electrically injured patients presenting with calvarial osteomyelitis, who admitted to the Emergency Unit Department of Neurosurgery Hasan Sadikin Hospital, All patients were males (100%). Their ages ranged between 24 and 51 years (average 23,7 years old) All patient (100%) suffered from calvarial osteomyelitis. Eight patient (77,7%) were high building worker at the time of incident, two patients were electric installation worker (18,18%). Entry point of electric wave 11 patients (100%) from head and outlet 11 patients (100%) from leg. Conclusion: Bone debridement in calvarial osteomyelitis is a difficult to treat infectious disease with a high relapse risk, cure is possible with appropriate treatment choices. Antibiotic treatment will provide more benefit if it is combined with appropriate and timely surgical treatment for both scalp and calvarial. socioeconomic conditions, and immunodeficiency syndromes [8], and also due to preexisting infectious focus, Local vascular insufficiency or hematogenous spread. The treatment involves a surgical and long term antibiotics for causative agent [9]. Methods Retrospectively report of high-voltage electrically head injured with underlying calvarial osteomyelitis from January 1 st 2011 to December 31 st 2013. Demographic information and the mechanism of injury complications, hospitalization period, surgical interventions and grading of burn injury and total body surface area of burn (TBSA) were recorded. Incomplete records and patients who had left the Hospital with written consent before the termination of their treatment course were excluded from the study (Table 1). Criteria for surgical procedures were high-voltage electrically head injured patients with underlying calvarial osteomyelitis who do not fulfill these criteria for admission are treated in the outpatient clinic until healing of their burn wounds or becoming ready for grafting. Results Eleven adult patients (11 males) were managed for high-voltage electrically head injured with underlying calvarial osteomyelitis

Chronic Osteomyelitis of Cranial Bones in a Patient with High-Voltage Electrical Burn on the Scalp: A Case Report

“…In a sense, chronic OM of the skull by high-voltage electrical burn on the scalp is inevitable, because complete and perfect debridement of the necrotic skull bone is practically impossible at the time of flap coverage, as previously described. Another study also reported that all patients suffered from calvarial osteomyelitis during treatments of high-voltage electrical burns on the scalp in 11 patients [1]. They reported that it was difficult to treat calvarial osteomyelitis due to a high relapse risk.…”

“…Complete debridement of necrotic tissue and bone with appropriate antibiotics is necessary [1]. If previous coverage was with a skin graft, flap coverage is desirable.…”

“…The incidence of electrical burn injuries is less than 5% of admissions to major burn centers in the United States. The mortality rate is 3%∼15%, with approximately 1000 deaths per year in the United States [1].…”

“…The scalp is an easily accessible part of the human body for high-tension electrical wires [2]. High-voltage electrical currents can often cause deep scalp and calvarial burns [1]. Progressive scalp necrosis causes scalp defects, resulting in cranial bone exposure that would require flap coverage.…”

Chronic osteomyelitis of the right femur after electrical burn: A case report

“…The upper limb has been reported as the most common entry point for electrical injury [ [8] , [9] , [10] ]. However, the scalp has also been reported as a common entry point for electrical injury, though less frequently than the upper limb [ 5 , 11 ]. Our patient had an entry point on the right elbow and an exit point on the lateral aspect of the right thigh.…”