Primary reconstruction of skull vault defects after burns

Abstract

Restoration of skull vault defects is especially important in the early stages of treatment, which minimizes the number of purulent and necrotic complications involving both the skull and the underlying deep structures.

Оbjective: To develop the most rational approach and surgical tactics for the rehabilitation treatment of patients with defects of the cranial vault after burns under conditions of primary reconstruction.

Materials and methods: We observed 16 patients with cranial vault lesions aged from 2 months to 46 years (average age, 25.3 years). Three groups of patients were identified.

- Lesions of superficial tissues without periosteal involvement (4 patients 25.0%);

- Soft tissue and periosteum lesions with exposure of the cortical bone layer (6 patients, 37.5%).

- Deep soft tissue and bone lesions (6 patients, 37.5%)

Depending of the depth, area of damaged tissue and localization of the defect, as well as the presence of unaffected areas, skin grafting, revascularizing interventions using complex flaps, bone milling or removal were used.

Results: The engraftment of skin grafts in patients in whom this method was used as the primary technique for closing defects was 70%. Complete engraftment of local and regional flaps occurred in all cases. Necrosis of up to 30% of the trapezius muscle flap occurred in one case. The study demonstrated the possibility of primary closure of cranial vault defects in patients with various lesions of anatomical structures.

Conclusions: The use of a differentiated approach to the treatment of skull vault defects ensures favorable therapeutic outcomes for patients.