J Trauma Inj.  2020 Mar;33(1):48-52. 10.20408/jti.2019.037.

Successful management of a Comatose Patient with Traumatic Brain Exposure with a fronto-Parieto-occipital flap

Affiliations
  • 0Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State,

Abstract

Composite skull defects in patients with severe head injuries are very challenging to manage. The dilemma when deciding whether to perform a definitive reconstruction is how long to wait for physiological recovery before an intervention complicates the situation. The inability of such patients to tolerate prolonged anesthetic exposure is a driving factor for performing the minimal intervention necessary to facilitate recovery. Herein, we present a case involving the successful immediate reconstructive treatment of a severely head-injured adolescent with a composite scalp defect secondary to trauma. A 14-year-old boy sustained a severe head injury from a motor vehicle accident with a composite scalp defect in the right fronto-parietal region. The frontal lobe was exposed, and the right eye was crushed and devitalized. The patient was deeply unconscious for 3 days, without any significant improvements before reconstructive surgery was proposed due to fear of possible meningitis resulting from the exposure of brain structures. We successfully managed the patient with a fronto-parieto-occipital flap, after which the patient promptly recovered consciousness.


Keyword

Composite scalp defect; Head injury; Flap; Unconsciousness
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