電撃傷による頭蓋骨露出の1例

A Case of Electrical Injury of the Scalp and Skull

はじめに

　電撃傷とは，生体の体表や体内を電気が通電して起こる組織損傷の総称である。電流の入出部では，高熱を発して熱傷を起こす。進行性に組織傷害が生じるという特徴があり，早期に傷害範囲を特定することが難しい。

　今回われわれは，電撃傷により頭蓋骨露出を伴う頭頂部皮膚欠損を生じた1例を経験した。治療を行い良好な転帰をたどったので，若干の文献的考察を加えて報告する。

　A 63-year-old-male electrician was electrocuted by a 6,600 V alternating current and suffered electrical injuries at his left fingers, right forearm, right elbow, and top of the head. Conservative treatment was performed, but at 50 days after the injuries the patient’s skull was still exposed. At 70 days post-injuries, the skin defect was reconstructed with the use of a scalp rotation flap. The postoperative course was uneventful.

　Since electrical injuries cause progressive tissue necrosis, the extent of necrosis can be difficult to determine. It has been suggested that when similar electrical injuries and cicatrization are acceptable, it’s desirable to reconstruct the defect after the precise extent of necrosis is clear. Since an exposed skull carries the risk of osteonecrosis, it should be covered with a flap as soon as possible.

　As the present case indicates, the optimal timepoint for reconstruction should be determined carefully based on close observations of the wound.