Farid Yudoyono*, Agung Budi Sutiono and M Zafrullah Arifin
Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
Received: 23 December, 2015; Accepted: 25 January, 2016; Published: 27 January, 2016
Farid Yudoyono, MD, Department of Neurosurgery, Faculty of Medicine Universitas Padjadjaran–Dr. Hasan Sadikin Hospital, Jl. Pasteur No. 38, Bandung 40161, Indonesia. Tel: +62222041694; Fax: +62222041694; E-mail:
Yudoyono F, Sutiono AB, Arifin MZ (2016) High-Voltage Electrically Head Injury Presenting underlying Calvarial Osteomyelitis: Single Indonesian Tertiary Hospital Experience. J Surg Surgical Res 2(1): 010-013.10.17352/2455-2968.000022
© 2015 Yudoyono F et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Calvarial Osteomyelitis; High voltage electrical injuries; Scalp flap
Objective: To demonstrate the characteristic of high-voltage electrically head injury patients presenting underlying calvarial osteomyelitis.
Methods: Retrospectively report of patients high-voltage electrically head injured with calvarial osteomyelitis from January 1st 2011 to December 31st 2013. The demographic variable namely age, sex, place of accident, present of calvarial osteomyelitis, Glasgow coma scale, surgical treatment type, grading of burn injury and total body surface area of burn (TBSA).
Results: Eleven high-voltage electrically injured patients presenting with calvarial osteomyelitis, who admitted to the Emergency Unit Department of Neurosurgery Hasan Sadikin Hospital, All patients were males (100%). Their ages ranged between 24 and 51 years (average 23,7 years old) All patient (100%) suffered from calvarial osteomyelitis. Eight patient (77,7%) were high building worker at the time of incident, two patients were electric installation worker (18,18%). Entry point of electric wave 11 patients (100%) from head and outlet 11 patients (100%) from leg.
Conclusion: Bone debridement in calvarial osteomyelitis is a difficult to treat infectious disease with a high relapse risk, cure is possible with appropriate treatment choices. Antibiotic treatment will provide more benefit if it is combined with appropriate and timely surgical treatment for both scalp and calvarial.
Electrically head injured are extremely rare and pose a difficult challenge for neurosurgeon, Electrical injuries account for less than 5% of admissions to major burn centers. The mortality is reported to be between 3% and 15%, with about 1000 deaths a year in the United States attributed to electrical injury [1-4]. The disability of electrotrauma depends not only the nature of the voltage current (DC or AC), but also the length of exposure, location and contact resistance of different tissues. Electrotrauma is divided between higher (>1000 volts) and lower (1000 volts) voltage injuries [1,2,5]. High-voltage (>1000 volts) electrical current, it often causes deep scalp and calvarial burns when enters into the body from the head present serious challenges in early and late stages of healing, underlying dura and cerebrum may be severely injured; moreover, neurological deficits caused by intracranial hemorrhage leading to loss of consciousness, sensory and motor deficiencies may occur. No difference management but cerebral involvement are more devastating and frequently end with a destructive condition .
Osteomyelitis is an infection process accompanied by bone destruction caused by a microorganism . The incidence is on the rise in developing countries because of malnutrition, poor socioeconomic conditions, and immunodeficiency syndromes , and also due to preexisting infectious focus, Local vascular insufficiency or hematogenous spread. The treatment involves a surgical and long term antibiotics for causative agent .
Retrospectively report of high-voltage electrically head injured with underlying calvarial osteomyelitis from January 1st 2011 to December 31st 2013. Demographic information and the mechanism of injury complications, hospitalization period, surgical interventions and grading of burn injury and total body surface area of burn (TBSA) were recorded. Incomplete records and patients who had left the Hospital with written consent before the termination of their treatment course were excluded from the study (Table 1).
Criteria for surgical procedures were high-voltage electrically head injured patients with underlying calvarial osteomyelitis who do not fulfill these criteria for admission are treated in the outpatient clinic until healing of their burn wounds or becoming ready for grafting.
Eleven adult patients (11 males) were managed for high-voltage electrically head injured with underlying calvarial osteomyelitis
All patients were males (100%). Their ages ranged between 24 and 51 years (average 23,7 years old) and the surface extent of burn ranged from 4 to 40% Total Body Surface Area (TBSA) average 23,72 %. Wound care average 15 days included 5 patient loss follow up caused by forced discharged due to financial problem and not controlled in outpatient clinic. GCS admission was 15 included one patient paraphrases caused by spinal cord injury. All patient (100%) suffered from calvarial osteomyelitis found radiographically or clinical assessment, Head CT scan not available for all patient due to limitation of insurance coverage. Eight patient (77,7%) were high building worker at the time of incident, two patients were electric installation worker (18,18%). Entry point of electric wave 11 patients (100%) from head and outlet 11 patients (100%) from leg.
Diagnosis of the type of electrical injury either as a low-voltage or a high-voltage injury was made according to the clinical examination and the history given by the patient, an attendant of the accident, or the medical report supplied by the medical facility that provided first aid management and/or transportation. Assessment of the type and depth scalp is confirmed subsequent debridements and dressing changes later intra-operatively during debridement.
Electrical injuries account for less than 5% of admissions to major burn centers. The mortality is reported to be between 3% and 15%, with about 1000 deaths a year in the United States attributed to electrical injury [1,2,6]. Electrical burns remain an important issue in developing countries due to its higher prevalence and complications mortality rate reported in literature as high as 59% [6,7]. Electrotrauma is frequently caused by work-related accidents. Handschin et al., show a large number of high voltage electrotrauma in connection with accidents at work (72%) .
Prolonged High-voltage electrical head injuries can be damage various types of tissue such as skin, subcutaneous tissue, muscles, nerves, tendons and blood vessels although rare calvarial destroys frequently both soft tissues and bony parts of the head and infection can occurs such as calvarial osteomyelitis on the inlet part (Figures 2A,B) [10,11].
- Ahmed AK, Nawres M (2006) Scalp Burns: Evaluation of Electrical Versus Thermal Scalp Injury. The Iraqi Postegraduate Medical Journal 5: 4.
- Lipový B, Kaloudová Y, Říhová H, Chaloupková Z, Kempný T, et al. (2014) High Voltage Electrical Injury: An 11-Year Single Center Epidemiological Study. Ann Burns Fire Disasters 27: 82-86.
- Makboul M, Abdel-Rahim M (2013) Simple flaps for reconstruction of pediatric scalp defects after electrical burn. Chin J Traumatol 16: 204-206
- Kaif M, Singh Panwar D, Chandra A, Chandra N (2009) High-voltage electrical burn of the head:Report of an unusual case, Indian Journal of Neurotrauma (IJNT) 6: 163-164.
- Lee J, Sinno H, Perkins A, Tahiri Y, Luc M (2010) 14,000 Volt Electrical Injury to Bilateral Upper Extremities: A Case Report. Mcgill J Med 13: 18-21.
- Ghavami Y, Reza Mobayen M, Vaghardoost R (2014) Electrical Burn Injury: A Five-Year Survey of 682 Patients. Trauma Mon 19: e18748.
- Soo Kim M (2012) Skull Osteomyelitis, Osteomyelitis, Prof. Mauricio S. Baptista (Ed.) 45-88.
- Raut AA, Nagar AM, Muzumdar D, Chawla AJ, Narlawar RS, et al. (2004) Imaging Features of Calvarial Tuberculosis: A Study of 42 Cases. AJNR Am J Neuroradiol 25: 409–414.
- Sümer S, Karamese M, Köktekir E, Ural O (2013) Chronic osteomyelitis of skull associated with necrotic injury after trauma: A case report. Journal of Microbiology and Infectious Diseases 3: 218-222.
- N Gümüş (2012) Negative pressure dressing combined with a traditional approach for the treatment of skull burn. Niger J Clin Pract 15: 494-497.
- Abd Al-Aziz H. Ahmad A, Al-Leithy I, Abu Alfotoh S (2004) Evaluation of the Treatment protocol of electrical injuries in Ain Shams University Burn Unit. Egypt J Palst Reconstr Surg 28: 149-158.
- Samuel JL, Matthew MH, Roman JS (2008) Scalp and Calvarial Reconstruction. Seminars in Plastic Surgery 22: 281-293.
- Ko SH, Chun W, Kim HC (2004) Delayed spinal cord injury following electrical burns: a 7-year experience. Burns 30: 691–695.
- Johl HK, Olshansky A, Beydoun SR, Rison RA (2012) Cervicothoracic spinal cord and pontomedullary injury secondary to high-voltage electrocution: a case report. J Med Case Rep 6: 296.
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