Banana Peel Flap for Reconstruction of Scalp Defect in Electrical

Burn Injury
Yesica*, Siti Osnurlita Ekasepti*, Guntoro*
*
Departement of Plastic Surgery, Gatot Soebroto Army Central Hospital, Jakarta, Indonesia

Abstract
Reconstruction of traumatic defects on the scalp can be challenging. In this present
case, a 35-years old man accidentally stunned by an electrical that lead to electrical
burn injury on his scalp. A 10x8cm skin, soft tissue, and bone necrosis occured on the
right side of fronto-parietal. Since bone exposure is identified, a multiple transposition
flap called banana peel flap is performed. The secondary defect resulting from the flap
covered with FTSG. A successful outcome was achieved by this technique.
Introduction
Severity of electrical burn damage depends on voltage, type of current, duration of contact
and tissue resistance.The repair of such defects is dependent upon their location, size, and
depth. Rotation, advancement, and transposition scalp flaps are the reference for
reconstructing these defects. Defects larger than 3 cm or with exposed bone should be
covered by a local flap or multiple local flaps such as “banana peel” method.

Case Report
A 35-years old man with a history of electrical burn injury on his scalp and previous
operation 2 months ago, came to Gatot Soebrot Army Hospital. Defect caused by
third degree burn wound size 10x8cm affected the right fronto-parietal region.
Because of the scar resulting from previous surgery that cut the pedicle artery, we
mobilized just 2 flaps rather than 3 flaps that usually perform in banana peel
technique. The secondary defect resulting from the flap covered with FTSG.

Figure 2. 10 days post

operative photo (side
Figure 1. Pre operative view)
photo
 Figure 3. 10 days post Figure 4. 8 weeks post
operative photo (front view) operative photo

Discussion
In this case, a patient with an electrical burn of the scalp and cranium is presented.
The choice between use of a transposition flap or a rotation flap is most often
influenced by the size of the defect. Defects larger than 3 cm should be covered by a
single or multiple flaps such as a “banana peel” method. Banana peel flap is an ideal
choice with a long-term durability, contour preservation, minimal donor site
morbidity and an acceptable cosmetic. 4 A successful outcome was achieved by a
proper surgical planning such as banana peel flap.
References
1. Strauch B, Vasconez L, Findlay E. Grabb’s Encyclopedia of Flaps, 2nd ed.h.11.
2. Kumar N, Paul K, Barreto E, Lamba S, Gupta A (2016) Management of scalp
defects due to high-voltage electrical burns: a case series and proposed algorithm
to treat calvarium injury. Eur J Plast Surg 39: 29-36.
3. Sokhal AK, Lodha KG, Kumari M, Paliwal R, Gothwal S (2017) Clinical
spectrum of electrical burns. A prospective study from the developing world.
Burns 43: 182-189.
4. Serras RP, Coelho R, Martin P, Mendes MM (2020). Reconstruction of post
electrical burn scalp defect with exposed bone. Science Repository.