Year 2021 Vol. 29 No 1

CASE REPORTS

K.V. LIPATOV 1, A.G. ASATRYAN 2, G.G. MELKONYAN 2, A.V. KIRILLIN 2, I.V. GORBACHEVA 1, E.I. DEKHISSI 1

THE APPLICATION OF NPWT TECHNIQUE IN TREATMENT OF AN EXTENSIVE INFECTED SUBGALEAL HEMATOMA IN AN ADULT

Sechenov First MoscowState Medical University (Sechenov University), Moscow,
4th Moscow Clinical Hospital, Moscow, Russian Federation2 , Moscow,
The Russian Federation

Negative pressure wound therapy (NPWT) has been proven to be one of the most effective techniques in the treatment of severely infected wounds of various origins and localizations. At the same time, the prospects for its application are constantly expanding. This clinical observation demonstrates the use of NPWT in the treatment of an adult patient hospitalized in severe condition with a picture of extensive post-traumatic infected subgaleal hematoma. The development of a generalized suppurative process was contributed both by the patients late request for medical help (18th day after the injury) and, as a consequence, the lack of primary surgical treatment of the scalp soft tissue injury, as well as the anatomical features of this area. The magnetic resonance tomography as instrumental examination methods played a significant role in the diagnosis of complications in addition to clinical data. Medical tactics was based on the surgical treatment of the infected focus, the application of antibacterial therapy, taking into consideration the isolated microbial flora (Streptococcus pyogenes). To eliminate severe inflammatory changes in the tissues and to reduce the size of the vast subaponeurotic cavity, NPWT technique was applied, which made it possible in short time to prepare a postoperative wound for surgical closure. The early secondary suturing at the final stage of treatment allowed obtaining a good result.

Keywords: infected subgaleal hematoma, surgical treatment, group A streptococcus, VAC-therapy, NPWT negative-pressure wound therapy
p. 116-120 of the original issue
References
  1. Goriunov SV, Abramov IS, Chaparian BA, Egorkin MA, Zhidkikh SIu. Rukovodstvo po lecheniiu ran metodom upravliaemogo otritsatelnogo davleniia. Moscow, RF: Aprel; 2013. 130 p. http://www.nda.ru/images/catalog/LR/Suprasorb%20CNP_book.pdf (In Russ.)
  2. Colditz MJ, Lai MM, Cartwright DW, Colditz PB. Subgaleal haemorrhage in the newborn: A call for early diagnosis and aggressive management. J Paediatr Child Health. 2015 Feb;51(2):140-46. doi: 10.1111/jpc.12698
  3. Sillero R de O. Massive subgaleal hematoma. J Trauma. 2008 Oct;65(4):963. doi: 10.1097/TA.0b013e31809ff3ce
  4. Singh AK, Buch K, Sung E, Abujudeh H, Sakai O, Aaron S, Lev M. Head and neck injuries from the Boston Marathon bombing at four hospitals. Emerg Radiol. 2015 Oct;22(5):527-32. doi: 10.1007/s10140-015-1322-9
  5. Razzouk A, Collins N, Zirkle T. Chronic extensive necrotizing abscess of the scalp. Ann Plast Surg. 1988 Feb;20(2):124-27. doi: 10.1097/00000637-198802000-00006
  6. Barry J, Fridley J, Sayama C, Lam S. Infected subgaleal hematoma following blunt head trauma in a child: case report and review of the literature. Pediatr Neurosurg. 2015;50(4):223-28. doi: 10.1159/000433442
  7. Wiley JF 2nd, Sugarman JM, Bell LM. Subgaleal abscess: an unusual presentation. Ann Emerg Med. 1989 Jul;18(7):785-87. doi: 10.1016/s0196-0644(89)80021-6
  8. NugentNF, Murphy M, Kelly J. Scalp abscess a cautionary tale. J Plast Reconstr Aesthet Surg. 2010 Aug;63(8):e619-21. doi: 10.1016/j.bjps.2010.02.011
  9. Chen CE, Liao ZZ, Lee YH, Liu CC, Tang CK, Chen YR. Subgaleal hematoma at the contralateral side of scalp trauma in an adult. J Emerg Med. 2017 Nov;53(5):e85-e88. doi: 10.1016/j.jemermed.2017.06.007
  10. Sayhan MB, Kavalci C, Sogut O, Sezenler E. Skull base osteomyelitis in the emergensy department: a case report. Emerg Med Int. 2011;2011:947327. Published online 2011 May 29. doi: 10.1155/2011/947327
  11. Duquenne C, Dernis E, Zehrouni A, Bizon A, Duquenne M. Streptococcus milleri: An unusual cause of skull extensive osteomyelitis in an immunocompetent patient. Rev Med Interne. 2017 Sep;38(9):628-32. doi: 10.1016/j.revmed.2017.01.011 [Article in French
Address for correspondence:
119991, Russian Federation,
Moscow, Bolshaya Pirogovskaya Str., 2-4,
I.M. Sechenov First Moscow
State Medical University,
The General Surgery Department.
tel. mobile +7 (916) 635-89-88,
e-mail: k_lipatov@mail.ru,
Lipatov Konstantin V.
Information about the authors:
Lipatov Konstantin V., MD, Professor of the General
Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-9902-2650
Asatryan Artur G., PhD, Head of the Purulent Surgery Unit, 4th Moscow Clinical lHospital, Moscow, Russian Federation.
http://orcid.org/0000-0002-8409-2605
Melkonyan George G., MD, Professor, Head Physician of the 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0001-7234-4185
Kirillin Alexey V., PhD, Deputy Head Physician for Surgery, 4th Moscow Clinical Hospital, Moscow, Russian Federation.
http://orcid.org/0000-0003-0585-9941
Gorbacheva Irina V., PhD, Associate Professor of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0002-1060-1163
Dekhissii Ekaterina I., PhD, Assistant of the General Surgery Department, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
http://orcid.org/0000-0003-4143-3593
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