An 81-year-old woman with a medical history of hypertension, type 2 diabetes mellitus and dementia syndrome was treated as outpatients with candesrtan + hydrochlorothiazide, metformin, clopidogrel, donepezilazepam, ciam.
She comes to the emergency department for falls from her own height with traumatic brain injury, as a result of which she has excoriation and vesicular hematoma occupying the frontal region and extending to the supra region.
It is normal and hemodynamically stable, without neurological deficit.
Computed tomography (CT) revealed the presence of intracranial lesions, and only the hematoma was identified.
She was discharged from the Emergency Department for primary health care.
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Three days later he returned to the emergency room after suffering an episode of prostration and failure to eat, being diagnosed with lower urinary tract infection and initiating empirical treatment with amoxicillin/clavulanic acid.
She was referred again to the emergency room by her bedside physician 7 days after the initial event for presenting inflammatory signs and increased epicraneal hematoma with associated tension.
The patient remained apyretic.
The lesion was drained and 300 cc of blood was extracted. Compressive bandaging was applied. The patient was discharged with maintenance of antibiotic therapy already initiated in the previous emergency episode.
Eleven days after the trauma, the patient was admitted to the emergency room again due to purulent fetid drainage in the lesion area.
The patient is still apyretic and has an extensive area of necrosis, well defined, occupying the entire frontal region.
We performed partial debridement of the lesion and decided to hospitalize for control of local infection, care of bandage and plate the subsequent reconstruction procedure.
Local cures were initiated with the exception of local inflammatory signs and exudation.
After 14 days of daily healing presents bone callus exposure with partial muscle preservation, loss of substance to ciliary region bilaterally and marginal necrosis.
We chose at this time to isolate and protect the eyebrows with Stomahesive® (ConvaTec, Deeside, UK), and start NPT 125 mmHg continuously with Antonio U.S.A. system.
The dressing was removed 72 hours later, a scarce serous drainage appeared and granulation foci were found on the bone surface.
We decided to place intephase in the granulation regions with compact chymosis and maintain continuous NPT at 125 mmHg for 17 days, with changes every 72 hours.
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The progressive cleaning of the lesion, the increase in granulation tissue and the slight decrease in the size of the wound from its margins were observed.
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After 17 days, given the favorable local conditions of the wound, we covered the defect with an expanded partial skin graft 1:1.5 with dimensions of approximately 16 x 9 cm, taken from the right hip.
During the postoperative period, care was maintained with conventional bandage and graft surveillance, with progressive wound healing.
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The patient was discharged for treatment in the outpatient Plastic Surgery clinic after 46 days of hospitalization, 15 days after the completion of the graft, with small bloody areas that healed by second intention, during the outpatient healing.
