[SavageGlow]

A 5-month-old infant boy was brought to the emergency department along with his mother and elder brother, all being inflicted by bites from neighbor's dog. Although the elder brother and mother sustained only scratches, the dog dragged the infant's head from his mother's lap, while she was self-defensive and caused him severe injuries on his scalp. He had near total loss of scalp in vertex area measuring 10 cm × 12 cm with loss of periosteum, fractured and raised parietal bone with dural tear and brain matter bulge .

The infant was crying on admission, and there was no reported loss of consciousness or seizures or any other neurological symptoms. He was actively moving his four limbs. He was referred from a hospital at 500 km and looked pale and hypovolemic. His hemoglobin was reported to be 6 g%. On computed tomography (CT) scan, there was a fracture of the left parietal bone with brain excursion from the raised fractured bone defect measuring 2 cm × 2 cm. The infant was started with blood transfusion. The wound was thoroughly washed with normal saline, and anti-rabies immunoglobulins were infiltrated in the wound margins and the plane of avulsion of scalp. Antirabies vaccine was started, and the monitoring of dog was asked for. He was put on wide spectrum cephalosporins.

The child resuscitation was then continued in pediatric Intensive Care Unit. After stabilization, he was taken up for surgery under general anesthesia on the next day. On exploration, the neurosurgery team found 2 cm × 1.75 cm dural defect in the left high parietal area near to superior sagittal sinus with brain bulge. After the evacuation of the contused brain, they repaired the dural tear with pericranial fascia. A 2 cm × 2 cm bone defect with exposed periosteum was covered with transposition flap from occipital area of scalp (based on superficial temporal and retroauricular artery) . The thinness of skin and loose areolar tissue in infants, made this flap raising quite challenging. The flap was sutured partially to the margins of the wound for monitoring of any infection. The donor area was grafted with split thickness graft from the left side thigh. The graft donor area was dressed with multilayer dressing, and the medial and posterior side of dressing was covered with transparent adhesive film to avoid fecal or urinary contamination. Partial congestion of distal flap was noted intraoperative while suturing the flap, which got relieved with position change (right side of scalp was kept up, to help in venous drainage). To avoid the hassle of suture removal, only catgut suture was used.

The infant was kept electively intubated and on ventilator for proper immobilization of flap for next 4 days. His recovery progressed very fine, and he was extubated after grafting of the left over raw areas. No signs of wound infection were seen. The schedule of antirabies vaccine was followed, and the child was discharged on day 15 . The dog was also reported to be doing fine till that day. No significant complaints were found on fortnightly follow-up visits for the next 3 months. No neurological deficiency or delay in milestones is being report so far.

The parents of the infant have been explained about the need of cranioplasty by the age of 5 years and esthetic hair restoration procedures in later years.

[Mr.NoCredit]

Fuck all I can’t imagine how horrible his mother felt being helpless to save her child from a ravaging dog. Sorry for the child but my heart goes out to his mom.. she’ll carry that for years and years. The child won’t ever remember the event. He’ll just have fucked up hair for his life..