DOCTOR FIRST AND DOCTOR FOREMOST-THE COMPLICATED CASE OF AN INFECTED SKULL

Hi all..............I am trying to recover data from one of  my external hard discs.It is very valuable to me because it contains videos and photos of my patients, videos and photos of my late mother and many of my travel videos and photos.I had given it to a local data recovery company.After trying for three months,they now tell me that it is unreadable.So I have now given it to Seagate service centre itself since it is a Seagate hard disc.Someone sold it to me with a different casing.So I didnot even know that it was a Seagate disc.The service company is telling me that most probably they would not be able to do anything since so much tampering has been done. And I am praying to god every waking minute so that a miracle can happen. Those of you who believe in God,please pray for me.

No this just the casing.I do not have the hard disc with me.I am telling you this because it is relevant to a patient of mine.It was a long time back in Kolkata .This patient was brought to me by one Singh ,a staff of my hospital. 

The patient had sustained multiple burn injuries when he was standing in a puddle of water in the roof of his house in Bihar after heavy rains.And due to the heavy rains,a high tension wire running above his head snapped and fell on his head.He would have died on the spot.But he survived with multiple burn injuries.

And the fact that water is a very poor conductor of electricity saved the poor man's life.But he had sustained severe burn injuries in his head ,and both lower limbs.He was treated for a long time in several top centres in India and they cured the burns ,applied skin grafts and made him successfully ambulatory.But the top of the head was burnt and there was no skin there.And the skull was exposed.

His relatives were taking him to Vellore Christian medical college hospital ,since in those days facilities for treating complicated cases were limited and Vellore was the final say for most of the patients.

And Singh was one of the relatives and the relatives of the patient had come to take the opinion of Singh since he was a hospital staff. And Singh came to take my opinion!!! Those days I was not a bit frightened to take on complicated cases and I used to take high risks willingly leaving all to God. So I assured them that I will operate on the patient.

All sorts of investigations were done.The Xray of the head showed infection in both tables of skull bone on top of the head.

 Now I would like to tell you about the basic anatomy of the head.On top of the head the skull bone or Cranium is directly under the skin of the scalp.It is tightly covered by a very thin layer of Periosteum. And the skull bone has two layers called "Tables" and there is only spongy bone between the tables.

CUT SECTION OF HEAD SHOWING THE TWO TABLES OF THE SKULL BONE
WITH SPONGY LAYER BETWEEN THE TABLES

LAYERS OF THE HEAD FROM SKIN TO BRAIN

And the brain ,the most vital portion of the body,is underneath the Cranium"skull bone" with only three layers of covering,the Duramater,the Arachnoid mater and the Piamater. They are known as the"meninges".The duramater is quite tough but it is not very thick. The arachnoid membrane is a thin, filmy tissue that is one of the three coverings of the brain, the meninges. It normally encloses the subarachnoid space, which is filled with cerebrospinal fluid, a water-like fluid that surrounds the brain and spinal cord.

Then there is the piamater which closely covers the brain and goes into each and every crevice of the brain.The brain is thus only protected by a thin layer of scalp,two tables of cranium and three layers of covering of brain itself.The cerebrospinal fluid also aids in buffering injuries to the brain.

But there is no thick muscular covering on top of head.So the brain is vulnerable to injuries. So our patient sustained severe burns on top of his head and lost the scalp,exposing the cranium.There was round large defect in the head almost covering all of the top.

Here I would like to mention that a scalping injury can occur in road traffic accidents.I have treated  some such patients who managed to survive.And the Red Indians were famous for taking out the scalps of their victims,dead or alive.And they used to hang them in their tents as trophies And the Red Indian with the most scalp trophies would be most respected.

A RED INDIAN SCALPING A LIVE MAN

SCALP TROPHIES INA RED INDIAN TENT

Back to our patient. Unfortunately he had infection in both the tables of the skull bone.So the top of the cranium had to be sacrificed leaving the duramater of brain exposed.I had taken several photographs before surgery was performed. But they may be lost if the hard disc data recovery is not complete.So this the the reason I talked about my hard disc before. I will feel very bad if the pre operative pictures of the patient are lost.

Anyway I roped in one of my senior colleague,a neurosurgeon.He removed both tables of the cranium on top of the head within half an hour. Then it was my turn .I made incisions on the sides of the huge wound and created two rotation flaps,undermined them,rotated them to cover the exposed brain.

I am not a good artiste and my photographs of the flaps remain in my hard disc in an  uncertain condition. So I am trying to make you imagine what I did.The base of the flaps were wider than depicted in this picture.But even then I was unsuccessful in covering the whole brain.A small coin defect remained.And I spent several nights worrying about infection to the brain .And I changed the dressings myself.But ultimately the raw area healed and the skin flaps united covering the top of the head completely.I was successful in my venture.Thank God.

A doctor treats,God cures.

The patient was a compounder in a dispensary in Bihar. He returned to his home very happy.And after two months came back for a review.The wound had completely healed.I advised him  to go in for another surgery to attach a synthetic covering on the brain.But he declined.So I asked him to always protect his head with a thick cap and remain extra careful.I wanted to review the patient further but he never turned up after that.

MY PATIENT

HEALED ROTATION SKIN FLAPS

Well the only thing is the brain is directly under the skin and the patient has to be very cautious to avoid injuries to the head.I just shared with you one of my favourite cases.

THANK YOU AND DO PRAY FOR MY HARD DISC