Effective administration of cranial drilling therapy in the treatment of fourth degree temporal, facial and upper limb burns at high altitude: A case report

Abstract

BACKGROUND

Fourth degree burns damage the full thickness of the skin and affect underlying tissues. Skin grafting after debridement is often used to cover the wounds of salvageable severe burns. A granulation wound can be formed by drilling the skull to the barrier layer to solve the problem of skull exposure. Low oxygen levels present at high altitudes aggravate ischemia and hypoxia which can negatively impact wound healing. The impaired healing in such cases can be ameliorated by hyperbaric oxygen therapy.

CASE SUMMARY

We describe a patient who presented with fourth degree burns to the left temporal and facial regions upon admission in December 2018. The periosteum of the skull and the deep fascia of the face were exposed. After the first stage of debridement and skin grafting, the temporal skin did not survive well. Granulation was induced by cranial drilling, and then a local flap was transferred to cover the wound. The left temporal and facial wounds were completely covered and the patient recovered well.

CONCLUSION

Skin grafting and flap transfer after early debridement to cover the wound and control infection were of great significance. In the later stages of the patient’s treatment, survival of the skin graft and skin flap was observed. The second stage repair was performed to achieve successful skin grafting by cranial granulation. Granulation was formed by drilling the skull, and then the wound was closed, which is suitable for cases with skull exposure and wounds with poor blood supply. We consider that hyperbaric oxygen treatment and improving tissue oxygen supply were beneficial in this patient.

Keywords: Fourth degree burn; Skull exposure; Chronic wounds; Cranial drilling therapy; High altitude area; Case report

Core Tip: We report the case of a female patient who suffered a fourth degree burn in the left temporal part of her face. This followed an episode of syncope which led to her collapse onto a fire basin. Skull periosteum and facial deep fascia were exposed resulting in complications with wound repair. As head and facial burn wounds were not suitable for early escharectomy, she was treated with systemic nutritional support, local wound exposure, debridement and skin grafting at a later stage. The patient was given a skin graft from the thigh, but some of the skin slices were observed to have survived poorly, resulting in further skull exposure. The skull was drilled to induce granulation, and the wound was closed with a local flap transfer. Due to the patient living in Xi’ning City which has an altitude as high as 2260 m above sea level, hyperbaric oxygen therapy was given repeatedly from initial admission until the local flap transfer operation to cover the exposed skull wounds. This was beneficial to the patient’s recovery and survival of the skin flap.