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Case Reports
Expediting venous drainage in large anterolateral thigh flaps for scalp electrical burns in India: two case reports on the use of primary vein grafts for second vein anastomosis
Jyotica Jagadish Chawaria, Parvati Ravula, Nazia Tabassum, Srikanth Rangachari
J Trauma Inj. 2023;36(4):404-410.   Published online November 30, 2023
DOI: https://doi.org/10.20408/jti.2023.0054
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AbstractAbstract PDF
Large scalp defects resulting from high-voltage electrical burns require free flaps, preferably skin, to permit optimal coverage and enable future or simultaneous cranial vault reconstruction. The anterolateral thigh permits the harvest of a large area of skin supplied by a reliable perforator. The superficial temporal vessels offer the proximate choice of recipient vessels to enable adequate reach and coverage. The lack of a second vein at this site implies the inability to perform a second venous anastomosis; however, this obstacle can be overcome by using an interposition vein graft, to the neck veins primarily. This assures adequate venous drainage and complete flap survival.
Summary
Successful management of a Comatose Patient with Traumatic Brain Exposure with a fronto-Parieto-occipital flap
Charles Chidiebele Maduba, Ugochukwu Uzodimma Nnadozie
J Trauma Inj. 2020;33(1):48-52.   Published online March 30, 2020
DOI: https://doi.org/10.20408/jti.2019.037
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AbstractAbstract PDF

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.

Summary
Surgical Treatment of Squamous cell Carcinomas Arising in Scalp Burn Wounds: Two Case Reports
Kang San Kim, Hyung Sik Hwang, Heum Dai Kwon, Seung Myung Moon, Suk Jun Oh, Sun Kil Choi
J Korean Soc Traumatol. 2007;20(1):52-56.
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AbstractAbstract PDF
Marjolin's ulcer is a rare and often-aggressive cutaneous malignancy that arises in previously traumatized or chronically inflamed skin, particularly after burns. We experienced two cases after burns. Case I involved a forty eight year-old man who had suffered from a flame burn at the parietal scalp area, where had been initially described three years earlier as a full-thickness wound including the pericranium. The man consulted us for a persistent ulcerative and infected wound on the burned lesion during the last 24 months, which turned out on the contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) to be the squamous cell carcinoma with involving the skull and the dura mater. Although the posterior auricular lymph node was enlarged on the ipsilateral side, recent positron emission tomography (PET) CT did not show any metastatic lesion. It was impossible for us to resect the intracranial involvement of the tumor radically, and the postoperative PET CT still showed a focal fluorodeoxyglucose (FDG) uptake around the wall of the superior sagittal sinus. We think that an aggressive combined approach is essential for treatment in early stages for a high success rate, before the intracranial structures are involved because there is no consensus on the treatment for advanced disease, and the results are generally poor. Case 1 also did not involve a radical resection because of the intracranial invasion to the wall of superior sagittal sinus and the possibility of damage to the major cortical veins. He received adjuvant radiotherapy and must be followed periodically. Case 2 involved an eighty six year-old women who suffered from a painful scalp ulcer lesion after flame burns three years earlier. Unlike case 1, neither tumor infiltration into the dura nor lymph node enlargement was observed on the contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) CT. We did a radical resection of the tumor, including the involved bone, and a cranioplasty with bone cement.
Summary

J Trauma Inj : Journal of Trauma and Injury