{"title":"Simplified treatment of chronic scalp wounds with exposed skull.","authors":"John E Gatti, Robert B Sollitto","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Exposed cranial bone can present a considerable challenge to the reconstructive surgeon. Removal of the outer cortex of exposed skull bone has proven effective in the management of complex scalp wounds for which traditional reconstruction efforts were limited.</p><p><strong>Objective: </strong>To demonstrate a simplified approach for management of scalp wounds with exposed skull.</p><p><strong>Methods: </strong>Chronic wounds with exposed skull bone in elderly patients who were poor candidates for complex reconstructions were treated with removal of the exposed, outer bone cortex. The wounds involved desiccated, exposed bone and sites of superficial osteomyelitis with surrounding thin, atrophic skin that negated local skin flap reconstruction. Conscious sedation and local anesthesia were used during outpatient procedures. A rotating drill with a grinding burr was used to remove the outer cortical bone. The uncovered medullary bone was managed conservatively with moisturizing ointments and light dressings. The patients were followed as outpatients to document progress of wound healing. Skin grafting was not used.</p><p><strong>Results: </strong>Eight patients with exposed skull after treatment for invasive skin cancers were treated with removal of the outer cortex in the areas of exposure. The patients were elderly (mean age, 83 years), had numerous medical problems, and were poor candidates for complex surgery. Osteomyelitis was present in 3 patients. Seven patients with scalp wounds were successfully treated with cortical craniectomy, including a 92-year-old female with a large defect. A different female patient, with recurrent squamous cell carcinoma of the forehead after radiation, experienced disseminated cancer, and her wounds did not heal.</p><p><strong>Conclusion: </strong>Exposed skull bone is prone to desiccation and subsequent osteomyelitis if left untreated. Complex reconstructions may not be appropriate in many situations. Atrophic scalp skin, radiation injury, and scarring from previous skin cancer surgery often limit local skin flap options. Cortical craniectomy of the exposed skull bone is a simple, local technique that allows for healthy granulation tissue to develop. Conservative wound therapy ensuring a moist environment allows for secondary wound healing. Skin grafting may be used after a vascular base develops to shorten healing time.</p>","PeriodicalId":23752,"journal":{"name":"Wounds : a compendium of clinical research and practice","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Wounds : a compendium of clinical research and practice","FirstCategoryId":"3","ListUrlMain":"","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Exposed cranial bone can present a considerable challenge to the reconstructive surgeon. Removal of the outer cortex of exposed skull bone has proven effective in the management of complex scalp wounds for which traditional reconstruction efforts were limited.
Objective: To demonstrate a simplified approach for management of scalp wounds with exposed skull.
Methods: Chronic wounds with exposed skull bone in elderly patients who were poor candidates for complex reconstructions were treated with removal of the exposed, outer bone cortex. The wounds involved desiccated, exposed bone and sites of superficial osteomyelitis with surrounding thin, atrophic skin that negated local skin flap reconstruction. Conscious sedation and local anesthesia were used during outpatient procedures. A rotating drill with a grinding burr was used to remove the outer cortical bone. The uncovered medullary bone was managed conservatively with moisturizing ointments and light dressings. The patients were followed as outpatients to document progress of wound healing. Skin grafting was not used.
Results: Eight patients with exposed skull after treatment for invasive skin cancers were treated with removal of the outer cortex in the areas of exposure. The patients were elderly (mean age, 83 years), had numerous medical problems, and were poor candidates for complex surgery. Osteomyelitis was present in 3 patients. Seven patients with scalp wounds were successfully treated with cortical craniectomy, including a 92-year-old female with a large defect. A different female patient, with recurrent squamous cell carcinoma of the forehead after radiation, experienced disseminated cancer, and her wounds did not heal.
Conclusion: Exposed skull bone is prone to desiccation and subsequent osteomyelitis if left untreated. Complex reconstructions may not be appropriate in many situations. Atrophic scalp skin, radiation injury, and scarring from previous skin cancer surgery often limit local skin flap options. Cortical craniectomy of the exposed skull bone is a simple, local technique that allows for healthy granulation tissue to develop. Conservative wound therapy ensuring a moist environment allows for secondary wound healing. Skin grafting may be used after a vascular base develops to shorten healing time.
期刊介绍：
Wounds is the most widely read, peer-reviewed journal focusing on wound care and wound research. The information disseminated to our readers includes valuable research and commentaries on tissue repair and regeneration, biology and biochemistry of wound healing, and clinical management of various wound etiologies.
Our multidisciplinary readership consists of dermatologists, general surgeons, plastic surgeons, vascular surgeons, internal medicine/family practitioners, podiatrists, gerontologists, researchers in industry or academia (PhDs), orthopedic surgeons, infectious disease physicians, nurse practitioners, and physician assistants. These practitioners must be well equipped to deal with a myriad of chronic wound conditions affecting their patients including vascular disease, diabetes, obesity, dermatological disorders, and more.
Whether dealing with a traumatic wound, a surgical or non-skin wound, a burn injury, or a diabetic foot ulcer, wound care professionals turn to Wounds for the latest in research and practice in this ever-growing field of medicine.
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