Preservation of nonviable cranial bone after class IV electrical burns.

ABSTRACT

BACKGROUND: It has been suggested that preservation of nonviable cranial bone is possible in some selected cases in the absence of infection. METHODS: A series of ten male patients, mean age 29 +/- 7 with severe electrical scalp burns and nonviable cranial bone were managed conservatively. The patients were treated initially by soft-tissue debridement until the wound presented viable, clean margins. At 22 +/- 6 days after the burn, multiple burr holes were made in the nonviable bone, and the defect immediately covered with a well-vascularized scalp flap. Each patient's progress was documented during the hospital stay and during the follow-up for at least one year. RESULTS: The multiple burr holes filled with fibrous tissue and the contour of the skull was maintained in all 10 patients making the need of a secondary cranioplasty unnecessary. No postoperative infection, osteomyelitis, or cranial bone sequestration occurred. CONCLUSIONS: Even with moderately delayed management of contaminated electrical burns, partial excision of the necrotic bone with burr holes and flap coverage appears to be adequate.