![]() The patient was conscious, but mentally incapacitated with generally stable vital signs and no abnormalities detected in the heart and lungs. Hyperbaric oxygen therapy can improve the oxygen tension of wounds, increase the proliferation of fibroblasts, activate the function of white blood cells, control infection, promote the synthesis and maturation of collagen, promote the formation of blood vessels and accelerate wound healing. Low atmospheric oxygen levels at high altitudes aggravates ischemia and hypoxia in chronic ulcer wounds. ![]() This facilitates a good base for the next step of skin grafting and the transfer of a skin flap to cover the wound surface. For patients with soft tissue defects of the scalp, the skull can be drilled to the barrier layer to form a granulation barrier. The skull plate-barrier layer is rich in blood vessels. Moreover, it is associated with better improvement of neurological deficit than craniotomy, and the incidence of postoperative complications is also lower. Compared with traditional craniotomy, post-drilling drainage results in less trauma and has the key advantage of simpler operation. Accordingly, the treatment of chronic wounds is based on etiological treatment, such as complete wound debridement, decompression, control of patients' blood glucose and so on.Ĭranial drilling is widely used in neurosurgery and it plays an important role in the drainage of chronic subdural hematomas, ventricle drainage and the treatment of deep brain lesions. Common chronic refractory wounds include wounds caused by infection, pressure injury, diabetes mellitus, trauma, burns and arteriovenous ulcers. The goal of closing the wound can be achieved clinically by controlling infection, removing necrotic tissue, negative pressure-based suction through vacuum sealing drainage, ligating veins, skin grafting and flaps. For fourth degree burns affecting a local small area, local flap transfer or free flap can be used to cover the wound.Ĭhronic wound healing is defined by wounds that cannot achieve anatomical and functional integrity through a normal, orderly and timely repair process. Eschar formation and skin grafting are commonly used to cover the wounds of fourth degree burns after debridement. It is necessary to ensure that the body’s natural wound repair processes in patients with severe burns are supported to restore good skin condition. The wound surface has no vesicle formation, appears waxy white or scorched yellow in color and develops skin necrosis following dehydration to form an eschar. This was beneficial to the patient’s recovery and survival of the skin flap.įourth degree burns to the skin, also known as full thickness burns, and usually injure both layers of the skin (dermis and epidermis) along with underlying tissues such as bone and muscle. Due to the patient living in Xi’ning City which has an altitude as high as 2260 m above sea level, hyperbaric oxygen therapy was given repeatedly from initial admission until the local flap transfer operation to cover the exposed skull wounds. The skull was drilled to induce granulation, and the wound was closed with a local flap transfer. The patient was given a skin graft from the thigh, but some of the skin slices were observed to have survived poorly, resulting in further skull exposure. As head and facial burn wounds were not suitable for early escharectomy, she was treated with systemic nutritional support, local wound exposure, debridement and skin grafting at a later stage. ![]() ![]() Skull periosteum and facial deep fascia were exposed resulting in complications with wound repair. This followed an episode of syncope which led to her collapse onto a fire basin. Core Tip: We report the case of a female patient who suffered a fourth degree burn in the left temporal part of her face. ![]()
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