頭部Ⅲ度熱傷に対する手術後の慢性期に中枢神経障害を生じた1例

A Chronic-phase Central Nervous System Disorder After Surgery for a Third-Degree Burn on the Head

はじめに

　頭部Ⅲ度熱傷が頭蓋骨にまで到達した際，腐骨を含む壊死組織の十分なデブリードマンが必要となり，露出した骨に対しては血流が豊富な遊離組織移植による再建を要することも多い。今回われわれは，深部に及んだ頭部Ⅲ度熱傷に対し遊離筋弁による創閉鎖を行うも，慢性期に中枢神経障害を来たした症例を経験したので，文献的考察を加え報告する。

　When third-degree burns of the head reach the skull, it is necessary to perform adequate debridement of necrotic tissue (including necrotic bone) and to cover the exposed bone with tissue that has good blood flow. We report the case of a 69-year-old man who developed a central nervous system (CNS) disorder due to a direct intracranial spread of wound infection after he had undergone skin valvuloplasty for a third-degree burn injury on the head.

　The inner plate of the patientʼs skull, which was exposed after the removal of the external plate, may have been weakened by repeated local infection during the treatment of a third-degree burn that had reached his skull. We speculate that as a result of this, a superficial bacterial infection may have spread to the interior of the patientʼs skull during the chronic phase, resulting in the CNS damage. Although reports of local infection and CNS injury under the cranial skin flap are rare, our patientʼs case highlights the necessity of confirming the anatomical structures that communicate within and outside the skull as visualized by a presurgery computed tomography examination before the external plate is incised, and surgeons should keep these structures in mind when incising the external plate. A careful postoperative follow-up is also recommended, considering the possibility of subsequent infection.