Neonatal scalp haematoma and necrosis

Surgical drain induced subgaleal hematomas and skin necrosis in pediatrics: a case report

INTRODUCTION

Subgaleal drainage is often being used in craniotomy procedures. It's not only offers advantages but also carries a risk of life-threatening complications. Here, we present a rare case of subgaleal hematoma and skin necrosis caused by placement of subgaleal drainage in a pediatric patient after a craniotomy procedure.

CASE REPORT

We reported a 6-months-old child who came to our institution complaining of uncontrolled eye movements which occurred 4 months earlier. From the CT scan and MRI, it was found that the patient had a mass in his suprasellar region, which suggested a suprasellar tumor. She underwent a mass resection procedure, but unfortunately, 3 days after the surgical procedure, the wound appeared necrotic, with a blackish color around the drain. The necrotic wound was suspected due to vacuum subgaleal drain placement. The wound was cleaned and the suture removed, but the necrotic area was still there. Four days after the surgery, the patient clinical condition got worse. After 17 days of treatment with no significant improvement, unfortunately, the patient died.

DISCUSSION

The mechanism of subgaleal hematoma and skin necrosis induced by the Redon drain possibly related to mechanical compression by the drain, which damage perforating vessels and subsequently disrupt skin vascularization, combined with vascular stasis as given by negative pressure of the drain. This induced skin ischemia lesion which later contributes the necrotic formation.

CONCLUSION

The subgaleal hematoma and skin necrosis as a complication of subgaleal redon drain in pediatric are rare phenomenon and likely under reported. The possible underlying mechanism was that drain's negative pressure disrupt subgaleal tissue and induce necrotic formation. Even the complication is rare compared to older children, yet it has been linked to an increased risk for infection, morbidity, and mortality.

A 9-day-old neonate with giant scalp abscess: A case report

RATIONALE

Neonatal scalp mass is common in clinical practice. After birth canal compression and traction force, a cephalohematoma is usually found. However, cephalohematoma with abscess is extremely rare and dangerous. So far, there have been no reported cases of multidrug-resistant Escherichia coli infections in giant neonatal scalp hematoma.

PATIENT CONCERNS

We present a 9-day-old with a scalp abscess and a large scalp defect that remained after surgical drainage.

DIAGNOSIS

Physical examination showed a giant mass suggestive in the parietal region. B-mode ultrasound indicated the scalp mass was liquid. The early diagnosis was massive scalp hematoma. During conservative treatment, purulent fluid flowed from the mass region through a rupture in the scalp. MR examination showed the scalp had burst and no abnormalities were found in the medial side of the skull and skull.

INTERVENTIONS

The surgeon opened up the mass and removed necrotic tissue. The scalp was severely damaged; the aseptic auxiliary materials that we made in-house were used to gradually reduce the defect.

OUTCOMES

The scalp was healed by anti-infection treatment and frequent changing of the dressings. The patient was successfully treated without two-stage surgery. There were no complications.

LESSONS

A scalp hematoma is a potential site of infection. Anti-infection treatment and surgery are necessary to correct infected scalp hematoma. This work offers a new way of treating other large scalp defects.

Full-thickness Scalp Injury Due to Hair Braiding and Weave

Full-thickness scalp necrosis secondary to hair weave placement is a rare but serious complication of a common hairstyle. The defects can be large and may necessitate complex reconstruction with hair-bearing tissue. We report on the case of a young woman with extensive scalp loss following tight spiral braiding. The case description illustrates this relatively unknown complication, its treatment, and possible preventative measures.