Reconstrucción de piel cabelluda (SCALP) con injerto de espesor parcial y expansor tisular secundario a mordedura de perro en paciente pediátrico

Abstract

Introduction. Large and complex scalp defects in pediatric patients represent a challenge for the plastic surgeon who faces this kind of injuries, due to the diffi - culty of the surgical techniques available in this age group. The primary goal in the management of this kind of wounds is to achieve adequate coverage of the cranial vault, with the main purpose of preventing bone exposure and sepsis. The secondary goal is to reach an aesthetic result, where alopecia can be attenuated, and the scars hidden. Objective. The objective of this work is to present the sequential surgical management for the reconstruction of complex scalp wounds with adequate aesthetic results. Material and methods. We present the case of a 1-year-old child who was bitten by a dog, presenting a full-thickness wound on the scalp in the parieto-occipital region, with skin coverage loss, primary reconstruction with a partial-thickness graft, and in the second surgical procedure, the use of tissue expanders for aesthetic purposes. Results: After 8 months with a total of 4 surgical procedures (1-antisepsis, edges remodeling, local flaps advance, harvesting and application of partial thick - ness skin graft with negative pressure system, 2-removal of negative pressure system, 3-placement of tissue expanders, 4-removal of tissue expanders, occipital flap advance and primary closure) a favorable aesthetic result is obtained. Conclusions. The management of scalp complex wounds in the pediatric population with partial thickness skin grafts has demonstrated efficacy by achieving immediate coverage of the defect with lower morbidity than other techniques, even more when using tools such as the negative pressure system, subsequent reconstruction with tissue expanders is an option in order to achieve sequelae reduction.