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Surgical drain induced subgaleal hematomas and skin necrosis in pediatrics: a case report

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Abstract

Introduction

Subgaleal drainage is often being used in craniotomy procedures. It's not only offers advantages but also carries a risk of life-threatening complications. Here, we present a rare case of subgaleal hematoma and skin necrosis caused by placement of subgaleal drainage in a pediatric patient after a craniotomy procedure.

Case report

We reported a 6-months-old child who came to our institution complaining of uncontrolled eye movements which occurred 4 months earlier. From the CT scan and MRI, it was found that the patient had a mass in his suprasellar region, which suggested a suprasellar tumor. She underwent a mass resection procedure, but unfortunately, 3 days after the surgical procedure, the wound appeared necrotic, with a blackish color around the drain. The necrotic wound was suspected due to vacuum subgaleal drain placement. The wound was cleaned and the suture removed, but the necrotic area was still there. Four days after the surgery, the patient clinical condition got worse. After 17 days of treatment with no significant improvement, unfortunately, the patient died.

Discussion

The mechanism of subgaleal hematoma and skin necrosis induced by the Redon drain possibly related to mechanical compression by the drain, which damage perforating vessels and subsequently disrupt skin vascularization, combined with vascular stasis as given by negative pressure of the drain. This induced skin ischemia lesion which later contributes the necrotic formation.

Conclusion

The subgaleal hematoma and skin necrosis as a complication of subgaleal redon drain in pediatric are rare phenomenon and likely under reported. The possible underlying mechanism was that drain’s negative pressure disrupt subgaleal tissue and induce necrotic formation. Even the complication is rare compared to older children, yet it has been linked to an increased risk for infection, morbidity, and mortality.

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All data generated or analyzed for this report are included in this published article.

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Acknowledgements

The authors would like to thank all the staff of Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga. We would also like to give our gratitude toward all who have contributed to and are involved in the process of these reports.

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Authors and Affiliations

  1. , Neurosurgery Department Dr. Soetomo General Hospital / Faculty of Medicine, Airlangga University, Surabaya, Indonesia

    Gigih Aditya Wardana

  2. Neuropediatric Division, Neurosurgery Department Dr. Soetomo General Hospital / Faculty of Medicine, Airlangga University, Surabaya, Indonesia

    Wihasto Suryaningtyas & Muhammad Arifin Parenrengi

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  1. Gigih Aditya Wardana
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  2. Wihasto Suryaningtyas
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  3. Muhammad Arifin Parenrengi
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Contributions

Gigih Aditya Wardana contributed to the conceptualization, data collection, writing, and editing of the study. Wihasto Suryaningtyas and Muhammad Arifin Parenrengi contributed to reviewing, editing, and finalizing the manuscript of the study.

Corresponding author

Correspondence to Muhammad Arifin Parenrengi.

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The authors declare no competing interests.

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This manuscript data was from the medical records of the patients at RSUD Dr. Soetomo and the patient has already given “inform consent” form for this report.

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Wardana, G.A., Suryaningtyas, W. & Parenrengi, M.A. Surgical drain induced subgaleal hematomas and skin necrosis in pediatrics: a case report. Childs Nerv Syst 39, 547–551 (2023). https://doi.org/10.1007/s00381-022-05614-4

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