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ISSN 1405-0625 (Print)

2019, Number 2

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Cir Plast 2019; 29 (2)

Scalp reconstruction with partial thickness graft and tissue expander secondary to dog bite in pediatric patient

Altamirano-Arcos C, Íñigo‑Arroyo F, Chávez‑Serna E, Andrade‑Delgado L, Apellaniz‑Campo AG, Carrillo‑Romero A, Íñigo‑Muñoz F, Guevara‑Valmaña OI

Language: Spanish
References: 24
Page: 236-242
PDF size: 340.71 Kb.


ABSTRACT

Large and complex scalp defects in pediatric patients represent a challenge for the plastic surgeon that faces these types of injuries, due to the difficulty of the surgical techniques available in this age group. The primary objective in the management of this type of wounds is to achieve adequate coverage of the cranial vault, with the fundamental purpose of preventing exposure, bone desiccation and sepsis and the secondary purpose will be the aesthetic result in which it will seek to attenuate alopecia and hide the scars. The objective of this work is to present the surgical management for the reconstruction of complex scalp wounds sequentially with good aesthetic results. We present the case of a one-year-old boy who was the victim of a dog bite, presenting a total thickness wound in the scalp of the parietal-occipital region, with loss of skin cover. The primary reconstruction was done with partial thickness grafts and in a second surgical time we used tissue expanders for aesthetic purposes. After eight months and a total of four surgical times (consisting of surgical washing, edge remodeling, advancement of local flaps, taking and application of partial thickness grafts with fixation by means of a negative pressure system, removal of the same, placement and removal of expanders, advance of occipital flap and primary closure) we obtained a favorable aesthetic result. In conclusion, the management of complex scalp wounds in a pediatric population with partial thickness grafts has proven effective in achieving immediate coverage of the defect with less morbidity than other techniques, even more when they rely on tools such as the negative pressure system. Subsequent reconstruction with tissue expanders is advisable to achieve sequelae reduction.


REFERENCES

  1. Dirección General de Epidemiología. Anuarios de Morbilidad 2014-2017. Sistema Único de Información para la vigilancia Epidemiológica. DGAE/SSA [citado el 20 de agosto de 2018] Disponible en: http://www.epidemiologia.salud.gob.mx/anuario/html/anuarios.html.

  2. Hernández ADA. Mordedura de perro: Enfoque epidemiológico de las lesiones causadas por mordedura de perro. Rev Enf Infec Pediatr 2009; 22.23 (89): 13-20.

  3. Kaye AE, Belz JM, Kirschner RE. Pediatric dog bite injuries: a 5-year review of the experience at the Children’s Hospital of Philadelphia. Plast Reconstr Surg 2009; 124 (2): 551-558.

  4. Velázquez RV, Flores AG, Pedroso BA. Treatment of craniofacial region wounds caused by dog bite. Rev Odontol Mex 2013; 17 (4): 243-250.

  5. Chen HH, Neumeier AT, Davies BW, Durairaj VD. Analysis of pediatric facial dog bites. Craniomaxillofac Trauma Reconstr 2013; 6 (04) 225-232.

  6. Alizadeh K, Shayesteh A, Li Xu, M. An algorithmic approach to operative management of complex pediatric dog bites: 3-year review of a level i regional referral pediatric trauma hospital. Plast Reconstr Surg Global Open 2017; 5 (10):1-6.

  7. Garvey EM, Twitchell DK, Ragar R, Egan JC, Jamshidi R. Morbidity of pediatric dog bites: a case series at a level one pediatric trauma center. J Ped Surg 2015; 50 (2): 343-346.

  8. O’Brien DC, Andre TB, Robinson AD, Squires LD, Tollefson TT. Dog bites of the head and neck: an evaluation of a common pediatric trauma and associated treatment. Am J Otolaryngol 2015; 36: 32-38.

  9. Macedo JL, Rosa SC, Queiroz MN, Gomes TG. Reconstruction of face and scalp after dog bites in children. Rev Col Bras Cir 2016; 43 (6): 452-457.

  10. Mcheik JN, Vergnes P, Bondonny JM. Treatment of facial dog injuries in children: a retrospective study. J Ped Surg 2000; 35 (4): 580-583.

  11. Fleisher GR. The management of bite wounds. N Engl J Med 1999; 340 (2): 138-140.

  12. Lee S, Rafii AA, Sykes J. Advances in scalp reconstruction. Curr Opin Otolaryngol Head Neck Surg 2006; 14: 249-253.

  13. Disa JJ, Pusic AL, Hidlgo DH, Cordeiro PG. Simplifying microvascular reconstruction: a rational approach to donor site selection. Ann Plast Surg 2001; 47: 385-389.

  14. Desai SC, Sand JP, Sharon JD, Branham G, Nussenbaum B. Scalp reconstruction: an algorithmic approach and systematic review. JAMA Facial Plast Surg 2015; 17 (1): 56-66.

  15. Fischer JP, Sieber B, Nelson JA, Kovach SJ, Taylor JA, Serletti JM et al. A 15-year experience of complex scalp reconstruction using free tissue transfer-analysis of risk factors for complications. J Reconstr Microsurg 2013; 29 (2): 89-97.

  16. Gurtner GC, Evans GRD. Advances in head and neck reconstruction. Plast Reconstr Surg 2000; 106: 672-682.

  17. Meyers B, Schoeman JP, Goddard A, Picard J. The bacteriology and antimicrobial susceptibility of infected and non-infected dog bite wounds: fifty cases. Vet Microbiol 2008; 127 (3-4): 360-368.

  18. Ali Z, Anjum A, Khurshid L, Ahad H, Maajid S, Dhar SA. Evaluation of low-cost custom made VAC therapy compared with conventional wound dressings in the treatment of non-healing lower limb ulcers in lower socio-economic group patients of Kashmir valley. J Orthop Surg Res 2015; 10: 183.

  19. Tan BK, Por YC, Chen HC. Complications of head and neck reconstruction and their treatment. Sem Plast Surg 2010; 24 (3): 288-298.

  20. Neumann CG. The expansion of an area of skin by progressive distention of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear. Plast Reconstr Surg 1957; 19 (2): 124-130.

  21. Fan J, Yang P. Aesthetic reconstruction of burn alopecia by using expanded hair-bearing scalp flaps. Aesthet Plast Surg 1997; 21 (6): 440-444.

  22. Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plast Reconstr Surg 2005; 116 (4): 54e-72e.

  23. Baker SR, Swanson NA. Tissue expansion of the head and neck: indications, technique, and complications. Arch Otolaryngol Head Neck Surg 1990; 116 (10): 1147-1153.

  24. Wagh MS, Dixit V. Tissue expansion: concepts, techniques and unfavorable results. Indian J Plast Surg 2013; 46 (2): 333-348.




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