Neonatal scalp necrosis: Long term sequelae and management: A case report

Scalp necrosis in the neonate is not an unheard of entity. It however, poses a treatment challenge because the neonatal calvarium is not ossified, and the dura is in close association with the skin. The neonatal susceptibility to sepsis also compounds the issue. We present a case of neonatal scalp necrosis. The child was treated in the newborn period and was on a regular follow-up. The plastic surgery, pediatric neurosurgery departments together with the pediatricians were closely involved in the management. He subsequently developed new onset behavioral problems which, after ruling out other common neurosurgical aetiologies, was attributed to contractures in the split skin graft used in the neonatal period. He was operated on again, wherein a vascularized free flap (latissimus dorsi − LD flap) was used. His behavioral disturbances abated considerably post-surgery. We consider this case unique, as the long-term sequelae of neonatal scalp necrosis, and its management is rarely mentioned in literature. Further, the behavioral disturbances which could be attributable to the graft fibrosis were a feature worth mentioning. We would also like to highlight the need for multidisciplinary co-operation to achieve the best results in children.