Electrical burns to the scalp and associated complications

Abstract

Electrical burns to the scalp are rare, and owing to hair coverage and the low index of suspicion, they are easy to miss. The main objective of this article is to highlight the presentation, management options and complications of the condition. A 46-year-old man with no known comorbidities had a delayed presentation with electrical burns to the scalp, legs and feet following an incident of assault. He was admitted to the Burn Unit, and supportive wound care commenced. He underwent several debridements, skin grafts of the legs and feet and left foot amputation, with improvement of the limb wounds. Despite grafting and repeated scalp wound debridement, the wound repeatedly became infected, with necrotic tissue and pus discharge. Successive tissue and wound swabs showed a varying range of bacteria that were treated with antibiotics. A computed tomography brain scan eventually showed osteomyelitis of the calvarium with sagittal sinus thrombosis. Scalp debridement and craniectomy were eventually performed in conjunction with neurosurgeons, with subsequent resolution of the wound. He was subsequently discharged with a protective helmet, with no further complications. A thorough evaluation of patients is invaluable for clinicians, and is advised in every clinical encounter. This case illustrates the challenges encountered in the management of these injuries. Thorough evaluation, repeated debridements, appropriate investigations and multidisciplinary teamwork helped to improve the outcome.