Management of class IV skull burns using the bipedicled superficial temporal artery scalp flap

Calvarial burns are extremely rare and pose a difficult challenge for both the burn and reconstructive surgeon. Reconstruction of these injuries is dependent on the depth of invasion and the amount of tissue loss. Fourth-degree burns include damage to the calvarium and the underlying dura and or cerebrum. Historically, these wounds have been treated conservatively. Two cases of electrical fourth-degree calvarial burns with large soft tissue defects as well as loss of calvarium and dura with cerebral herniation are presented. Each patient presented to Shriners Burn Hospital in a delayed fashion with infected wounds necessitating immediate intervention. Both patients were debrided and covered with a bipedicled superficial temporal artery scalp flap. The donor sites of each flap, as well as the remaining areas, were skin grafted. This flap provides immediate vascularized coverage in wounds that were unable to be treated conservatively. In the face of sepsis and other severe injuries where more complicated flaps are risky, this flap provides a reasonable and reliable method of calvarial coverage.