[abstract] EXTENSIVE CRANIAL VAULT OSTEOMYELITIS SECONDARY TO CHRONIC FOLLICULITIS DECALVANS TREATED WITH HBO FOR GRAFT PREPARATION

Abstract

A 77 year old caucasian female was referred for Hyperbaric Oxygen treatments for cranial vault osteomyelitis secondary to chronic Folliculitis Decalvans. The patient presented with an 8 year history of multiple skin grafting and debridrnent of the scalp. Bone scan and x-ray revealed cranial osteomyelitis. Culture results at time of admission revealed growth of Staph Aureus. The surface of scalp affected was over 70-80% of total scalp area with two large areas of exposed bone (approx. 3 x 2 cm and 2 x 1 cm. respectively). PMH included orthostatic hypotension, temporal lobe seizures, tic douloureaux, malnutrition (recent 20 pound weight loss), esophagitis, aspiration pneumonia, and multiple surgical procedures. Over the past 8 years the patient had multiple debridments and grafts which had failed. The patient also received concurrent antimicrobial therapy. Last surgical debridment was 8 days prior to starting HBO therapy. The patient received a total of 15 treatments at 2 atm abs for 60 minutes daily - 12 treatments were prior to grafting and 3 post graft. Within 4 treatments patient showed much improved perfusion of the exposed periostium with persistent improved coloration. Results were 100% take of graft as verified at 4 weeks. The therapy of Folliculitis Decalvans and cranial osteomyelitis have been problematic in the past. Although this was a severe manifestation of this disease with osteomyelitis, HBO therapy may have contributed to the control of both conditions and is worth further investigation.