title: Management of acute calvarial burns in children.
abstract: BACKGROUND
  Although rare, head burns involving the calvarium are a serious complication of burns and electrical injury, and present therapeutic challenges to the surgical burn care team. We evaluated our experiences and compared available strategies to address this challenge.
  
  
  METHODS
  Records of all burned children between January 1986 and December 2000 were reviewed. Twenty-seven children (15 boys and 12 girls) with scalp burns extending at least into the outer table of bone were identified and compared with a matched group of 30 patients admitted for acute thermal burns without skull injury.
  
  
  RESULTS
  Flame burn was the injury mechanism in 78% of these patients and electrical injury was the injury mechanism in 22%. The incidence of calvarial burns in our patient population was 1.2% for thermal burns and 5.6% for electrical injuries during the study period. The age distribution was biphasic, with maximums in infancy for thermal burns and in puberty for electrical injuries. Eight of 27 patients (29.6%) developed full-thickness calvarial bone defects. In 23 patients, calvarial burn wound coverage was achieved with bone debridement and immediate or delayed placement of autograft skin. In four patients (all with electrical injury), local scalp flaps were required for closure. The length of hospital stay and overall number of acute operative procedures significantly increased for patients with calvarial burns.
  
  
  CONCLUSIONS
  Acute calvarial burns are safely managed by bone debridement in combination with staged autografting or early flap coverage. Although flap coverage reduces the number of required procedures, the extensive wound size in thermal burns restricts acute flap procedures primarily to electrical injuries. Compared with patients without skull injury, length of hospital stay and the number of acute operative procedures are tremendously increased in patients with calvarial burns.
authors.affiliation: Shriners Hospitals for Children-Galveston Burn Unit, Department of Surgery, University of Texas Medical Branch, Galveston 77550-2725, USA.
authors.forename: Marcus
authors.initials: M
authors.lastname: Spies
authors.forename: Robert L
authors.initials: RL
authors.lastname: McCauley
authors.forename: Bradley P
authors.initials: BP
authors.lastname: Mudge
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
mesh_terms: D002056:Burns / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003646:Debridement; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012535:Scalp / Q000293:injuries* / Q000601:surgery; D016038:Skin Transplantation; D012886:Skull / Q000293:injuries* / Q000601:surgery; D013524:Surgical Flaps; D014182:Transplantation, Autologous; D016896:Treatment Outcome