Display options
Cite
Basyuni S, Panayi A, Sharma V, et al. A missed scalp laceration causing avoidable sequelae. Int J Surg Case Rep. 2016;23:61-4doi: 10.1016/j.ijscr.2016.04.012.
Basyuni, S., Panayi, A., Sharma, V., & Santhanam, V. (2016). A missed scalp laceration causing avoidable sequelae. International journal of surgery case reports, 2361-4. https://doi.org/10.1016/j.ijscr.2016.04.012
Basyuni, Shadi, et al. "A missed scalp laceration causing avoidable sequelae." International journal of surgery case reports vol. 23 (2016): 61-4. doi: https://doi.org/10.1016/j.ijscr.2016.04.012
Basyuni S, Panayi A, Sharma V, Santhanam V. A missed scalp laceration causing avoidable sequelae. Int J Surg Case Rep. 2016;23:61-4. doi: 10.1016/j.ijscr.2016.04.012. Epub 2016 Apr 11. PMID: 27088847; PMCID: PMC4855742.
Copy Download .nbib Format: NLM
Share it on

Int J Surg Case Rep. 2016;23:61-4. doi: 10.1016/j.ijscr.2016.04.012. Epub 2016 Apr 11.

A missed scalp laceration causing avoidable sequelae.

International journal of surgery case reports

Shadi Basyuni, Andreana Panayi, Valmiki Sharma, Vijay Santhanam

Affiliations

  1. Addenbrooke's Hospital, Cambridge, United Kingdom; University of Cambridge, United Kingdom. Electronic address: [email protected].
  2. Addenbrooke's Hospital, Cambridge, United Kingdom; University of Cambridge, United Kingdom.
  3. Addenbrooke's Hospital, Cambridge, United Kingdom.

PMID: 27088847 PMCID: PMC4855742 DOI: 10.1016/j.ijscr.2016.04.012

Abstract

INTRODUCTION: We present the case of an overlooked scalp laceration in an 81-year-old lady who presented with polytrauma following a fall down stairs. Complications that developed required more extensive treatment compared to what would have sufficed with early identification.

PRESENTATION OF CASE: Imaging on admission to hospital showed multiple vertebrae and rib fractures as well as a large cranial subcutaneous haematoma with no intracerebral bleed. Before the laceration was identified, the patient developed acute anaemia requiring transfusion. Continued reduction in haemoglobin levels called for a more thorough examination of the scalp. Investigation, following copious irrigation, revealed a large laceration. The presence of infection and necrotic tissue necessitated a general anaesthetic for debridement and closure.

DISSCUSSION: Diagnostic errors are more common in patients presenting with multiple or severe injuries. Initial management in trauma cases should focus on more evident or life threatening injuries However, it is important that reflections and recommendations are continually made to reduce diagnostic errors, which are higher in polytraumatised patients. Various factors including haemodynamic instability and patient positioning added to the elusive nature of this wound. Adequate examination of lacerations requires thorough cleaning as coagulated blood and other material may obscure findings. This is particularly important in scalp lacerations where the overlying hair can form a barrier that is effective at hiding the wound edges.

CONCLUSION: This case highlights the importance of a thorough secondary survey; an effective examination technique would have avoided the need for extensive treatment to manage the sequelae of the missed scalp laceration.

Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Keywords: Infection; Laceration; Maxillofacial; Reconstructive; Secondary survey; Wound healing

References

  1. Injury. 1987 Jan;18(1):15-7 - PubMed
  2. J Orthop Trauma. 1991;5(3):308-12 - PubMed
  3. J Trauma. 1990 Jun;30(6):666-9; discussion 669-70 - PubMed
  4. Aust N Z J Surg. 1993 Dec;63(12):935-9 - PubMed
  5. J Emerg Med. 1988 Sep-Oct;6(5):377-9 - PubMed
  6. West J Med. 1977 Aug;127(2):169-72 - PubMed
  7. South Med J. 2000 Mar;93(3):265-6 - PubMed

Publication Types