Shamakhyan H. V., Yaghjyan G. V.
REPUBLICAN BURN CENTER,
CENTER OF PLASTIC AND RECONSTRUCTIVE SURGERY & MICROSURGERY
Yerevan, Armenia
The amount of electrotraumas in children in the past decade was increased (3,8% - 1998, 1,7% - 1988) in connection with the worsening of monitoring on electricity transmission lines and insuf-fi-cient observance of the safety devises regulations in Armenia. The electroburns of a head on frequency of occurrence occupy the se-cond place after damages of the upper extremities and frequently are accompanied by extensive defects of soft tissues as well as osteonecrosis of a cranium.Tactics of treatment of electrotraumas of a head accepted earlier assumes the application of multiple holed craniotomy, which is in plotting of holed openings during 3-4 weeks after trauma, with further growth of granulations from the openings and expectation of osteorejection during 6-12 weeks after operation. The formed defect was closed by the splitted autotransplant. On the base of treatment experience of 12 patients with electrotraumas of cranium bones, we suggest the following treatment tactics: The superposition of holed openings on osteonecrosis edges with the diagnostic purpose, for de-ter-mination of necrosis boundaries and sizes of proposed defect (roentgenologically osteo-nec-rosis is revealed not earlier than 0.5 to 2 months after a burn);Resection of injured site - up to the healthy tissues. Inspection of dura mater (DM) with the purpose of detection of epidurial and subdural abscesses;Dissection of the necrotized tissues up to the healthy sites. Plasty of scalp defect (with diameter up to 14 cm) by the transition of local tissues taking into account the vascularization of flaps.The use of vascular flaps of scalp ensures the adequate integmentary, frame, aesthetic func-ti-ons, as well as the function of a full value both the biological medium and regeneration. Advantages of given tactics of treatment of patients are. Reduction of terms of treatment about 5 weeks.
- Decrease of probability of epidurial and subdural abscesses;
- Diminution of probability of remote neurological complications (formation of cicatrical adhesions with DM);
- Simplifies the techniques of secondary cranioplasty (the necessity of separatiion of rough cicatrical tissues from DM is passed);
- Expressed cosmetic effect.