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

• Maduba CC
• Nnadozie U

• KMID: 2501792
• DOI: http://doi.org/10.20408/jti.2019.037

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