Birk Harjus, Demand Audrey, Kandregula Sandeep, Notarianni Christina, Meram Andrew, Kosty Jennifer
Departments of1Neurosurgery and.
2Oral and Maxillofacial Surgery, Louisiana State University Health Shreveport School of Medicine, Shreveport, Louisiana.
J Neurosurg Case Lessons. 2022 Feb 21;3(8). doi: 10.3171/CASE21489.
The authors reported the first pediatric case of a craniocerebral gunshot injury successfully treated with a wound vacuum-assisted closure (VAC) device after dehiscence and infection of the initial cranial wound.
A 17-year-old boy suffered several gunshots to the left hemisphere, resulting in significant damage to the scalp, calvaria, and brain. Emergency hemicraniectomy was performed, with reconstruction of a complicated scalp wound performed at the initial surgery. The scalp was devitalized and ultimately dehisced, resulting in a cranial infection. It was treated first with a repeated attempt at primary closure, which failed because of persistent devitalized tissue, and was then treated with aggressive debridement followed by placement of a wound VAC device over the exposed brain as a bridge therapy to reconstruction. This procedure was deemed necessary given the active infection.
The patient received delayed reconstruction with a free split-thickness skin graft and made a remarkable recovery, with cranioplasty performed 6 months later. The authors reviewed the literature on wound VAC use in cranial wound treatment and proposed it as a legitimate bridge therapy to definitive reconstruction in the setting of dirty wounds, active infection, or even hemodynamically unstable patients.
作者报道了首例小儿颅脑枪伤病例，该病例在初次颅脑伤口裂开并感染后，成功使用伤口负压封闭引流（VAC）装置进行治疗。
一名17岁男孩左半球遭受多处枪伤，导致头皮、颅骨和脑部严重受损。进行了急诊去骨瓣减压术，并在初次手术时对复杂的头皮伤口进行了重建。头皮坏死最终裂开，导致颅内感染。首先尝试再次进行一期缝合，但因持续存在坏死组织而失败，随后进行积极清创，然后在暴露的脑组织上放置伤口VAC装置作为重建的过渡治疗。鉴于存在活动性感染，该操作被认为是必要的。
患者接受了延迟的游离分层皮片移植重建，并取得了显著恢复，6个月后进行了颅骨成形术。作者回顾了关于伤口VAC在颅脑伤口治疗中应用的文献，并提出将其作为在伤口污染、活动性感染甚至血流动力学不稳定患者中进行确定性重建的合理过渡治疗。
