Rehabilitation of Depressed Skull Fractures

About 20% of closed cranial brain injuries can be seen in skull fractures, of which about 3/4 are calvarial fractures, 1/4 are skull base fractures, and 28.6% are concave fractures in calvarial fractures. The vast majority of depressed fractures are trapped after the full-thickness of the skull, and some are trapped in the whole piece, but more are fragments of different sizes. The fracture line that is trapped around the fracture piece is annular or radial. The baby's skull is soft and can produce a table tennis-like depression that does not see the fracture line. If the depth of the sag fracture is less than 1cm, there is usually no dural laceration, which is called simple sag fracture. There is no need for emergency surgery after the injury. Those who need surgery can be re-executed after the condition is stable. Almost 2cm deep, there are almost dural lacerations, often accompanied by blood vessels and brain damage, called complex depression fractures, can cause brain dysfunction, hematoma and epilepsy, requiring surgical treatment. Treatment of diseases: closed head injury Indication 1. Those with a depression depth of 1 cm or more. 2. The fracture piece pierces the dura mater, causing bleeding and brain damage. 3. Due to the compression of the sag, causing hemiplegia, aphasia and localized epilepsy. 4. The person who is located on the frontal face affects the appearance. Contraindications 1. Mild sag fractures in non-functional areas. 2. A sinus depression with no brain compression symptoms. 3. Younger infants and young children may have self-recovery. If there is no obvious focal symptoms, they may not be operated temporarily. Preoperative preparation 1. Prepare the skin, wash the head with soap and water, and shave the hair. 2. Fasting before surgery. 3. 1 hour before surgery, 0.1 g of phenobarbital, 0.4 mg of atropine or 0.3 mg of scopolamine. Surgical procedure There are two ways to rectify: 1 free bone flap repair. 2 smashed the fracture piece of the depression. 1. Free bone flap repair 1 Make a horseshoe-shaped flap around the edge of the concave fracture. 2 Drill 4 bone holes around the concave fracture, and saw off between the bone holes to preserve the periosteum on the surface of the bone flap. 3 Peel off between the epidural and the inner plate of the skull to remove the entire bone flap. 4 The sag fracture is repaired by hand or other surgical instruments. 5 Check whether the dura mater is intact, whether there is a hematoma or brain contusion under the dura mater. If the dura mater has been torn, the fracture piece has been inserted into the brain, and the small bone piece should be removed, the blood and the broken brain tissue underneath it are removed, and the dura mater is sutured after strict hemostasis. 6 The reconstructed free bone flap was repositioned, the perforated periosteum was sutured, and finally the layers of the scalp were sutured by layer. 2. Pick up the fractured piece of the depression 1 scalp incision with the same free bone flap reduction. 2 Make a hole in the normal skull near the edge of the fracture and bite the partially overlapping bone along the edge of the fracture. 3 After the dura mater was removed under the sag fracture, the fracture piece was picked up and repaired. Make it reset. 4 suture the scalp. complication 1. Wound infection. 2. Osteomyelitis.