Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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Salvage of an exposed cranial prosthetic implant using a transposition flap with an indwelling antibiotic irrigation system

  • Hwang, Sung Oh (Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Chang, Lan Sook (Department of Plastic and Reconstructive Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine)
  • Received : 2019.11.04
  • Accepted : 2019.12.04
  • Published : 2020.02.20
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Abstract

Cranial implant removal is recommended if implants become exposed owing to scalp necrosis after cranioplasty. However, it carries the risk of extensive bleeding, and the resultant cranial defects can cause both aesthetic and functional problems. We present a case of a scalp defect exposing a cranial prosthetic implant that was reconstructed with a local flap and salvaged using an indwelling antibiotic irrigation system. A 73-year-old man presented with scalp necrosis after undergoing cranioplasty due to intracranial hemorrhage. The cranial implant was exposed through the scalp defect. Methicillin-resistant Staphylococcus aureus was detected in the culture from the open wound. After debridement of the necrotic tissue and burring of the superficial layer of the implant, a transposition flap was used to cover the defect and an indwelling antibiotic irrigation system was installed. Continuous irrigation with vancomycin was conducted for 5 days, and intravenous vancomycin was continued for 4 weeks. The flap was in good condition at 4 months postoperatively, with no infection. The convex contour of the scalp was well maintained. The patient's neurological status was stable. Exposed cranial implants can be salvaged with continuous antibiotic irrigation as an alternative to implant removal; thus, the risk of bleeding and possible disfigurement may be avoided.

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References

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