Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
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Staged reconstruction of a chronically infected large skull defect using free tissue transfer and a patient-specific polyetheretherketone implant

  • Moon, Seung Jin (Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Jeon, Hong Bae (Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Kim, Eui Hyun (Department of Neurosurgery, Yonsei University College of Medicine) ;
  • Lew, Dae Hyun (Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Kim, Yong Oock (Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine) ;
  • Hong, Jong Won (Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine)
  • Received : 2020.07.07
  • Accepted : 2020.10.14
  • Published : 2020.10.20
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Abstract

Reconstructions of extensive composite scalp and cranial defects are challenging due to high incidence of postoperative infection and reconstruction failure. In such cases, cranial reconstruction and vascularized soft tissue coverage are required. However, optimal reconstruction timing and material for cranioplasty are not yet determined. Herein, we present a large skull defect with a chronically infected wound that was not improved by repeated debridement and antibiotic treatment for 3 months. It was successfully treated with anterolateral thigh (ALT) free flap transfer for wound salvage and delayed cranioplasty with a patient-specific polyetheretherketone implant. To reduce infection risk, we performed the cranioplasty 1 year after the infection had resolved. In the meantime, depression of ALT flap at the skull defect site was observed, and the midline shift to the contralateral side was reported in a brain computed tomography (CT) scan, but no evidence of neurologic deterioration was found. After the surgery, sufficient cerebral expansion without noticeable dead-space was confirmed in a follow-up CT scan, and there was no complication over the 1-year follow-up period.

Keywords

References

  1. Honeybul S. Neurological susceptibility to a skull defect. Surg Neurol Int 2014;5:83. https://doi.org/10.4103/2152-7806.133886
  2. Dujovny M, Fernandez P, Alperin N, Betz W, Misra M, Mafee M. Post-cranioplasty cerebrospinal fluid hydrodynamic changes: magnetic resonance imaging quantitative analysis. Neurol Res 1997;19:311-6. https://doi.org/10.1080/01616412.1997.11740818
  3. Aydin S, Kucukyuruk B, Abuzayed B, Aydin S, Sanus GZ. Cranioplasty: review of materials and techniques. J Neurosci Rural Pract 2011;2:162-7. https://doi.org/10.4103/0976-3147.83584
  4. Lee JC, Kleiber GM, Pelletier AT, Reid RR, Gottlieb LJ. Autologous immediate cranioplasty with vascularized bone in highrisk composite cranial defects. Plast Reconstr Surg 2013;132:967-75. https://doi.org/10.1097/PRS.0b013e31829f4b59
  5. Reddy S, Khalifian S, Flores JM, Bellamy J, Manson PN, Rodriguez ED, et al. Clinical outcomes in cranioplasty: risk factors and choice of reconstructive material. Plast Reconstr Surg 2014;133:864-73. https://doi.org/10.1097/PRS.0000000000000013
  6. Lutz BS, Wei FC, Chen HC, Lin CH, Wei CY. Reconstruction of scalp defects with free flaps in 30 cases. Br J Plast Surg 1998;51:186-90. https://doi.org/10.1054/bjps.1997.0182
  7. Bonda DJ, Manjila S, Selman WR, Dean D. The recent revolution in the design and manufacture of cranial implants: modern advancements and future directions. Neurosurgery 2015;77:814-24. https://doi.org/10.1227/NEU.0000000000000899
  8. Choi JW, Kim N. Clinical application of three-dimensional printing technology in craniofacial plastic surgery. Arch Plast Surg 2015;42:267-77. https://doi.org/10.5999/aps.2015.42.3.267
  9. Persson J, Helgason B, Engqvist H, Ferguson SJ, Persson C. Stiffness and strength of cranioplastic implant systems in comparison to cranial bone. J Craniomaxillofac Surg 2018;46:418-23. https://doi.org/10.1016/j.jcms.2017.11.025
  10. Punchak M, Chung LK, Lagman C, Bui TT, Lazareff J, Rezzadeh K, et al. Outcomes following polyetheretherketone (PEEK) cranioplasty: systematic review and meta-analysis. J Clin Neurosci 2017;41:30-5. https://doi.org/10.1016/j.jocn.2017.03.028
  11. Thien A, King NK, Ang BT, Wang E, Ng I. Comparison of polyetheretherketone and titanium cranioplasty after decompressive craniectomy. World Neurosurg 2015;83:176-80. https://doi.org/10.1016/j.wneu.2014.06.003
  12. Fodstad H, Love JA, Ekstedt J, Friden H, Liliequist B. Effect of cranioplasty on cerebrospinal fluid hydrodynamics in patients with the syndrome of the trephined. Acta Neurochir (Wien) 1984;70:21-30. https://doi.org/10.1007/BF01406039
  13. Manson PN, Crawley WA, Hoopes JE. Frontal cranioplasty: risk factors and choice of cranial vault reconstructive material. Plast Reconstr Surg 1986;77:888-904. https://doi.org/10.1097/00006534-198606000-00003
  14. Kwiecien GJ, Aliotta R, Bassiri Gharb B, Gastman B, Zins JE. The timing of alloplastic cranioplasty in the setting of previous osteomyelitis. Plast Reconstr Surg 2019;143:853-61. https://doi.org/10.1097/PRS.0000000000005363
  15. Wind JJ, Ohaegbulam C, Iwamoto FM, Black PM, Park JK. Immediate titanium mesh cranioplasty for treatment of postcraniotomy infections. World Neurosurg 2013;79:207.
  16. Lopez J, Zhong SS, Sankey EW, Swanson EW, Susarla H, Jusue-Torres I, et al. Time interval reduction for delayed implantbased cranioplasty reconstruction in the setting of previous bone flap osteomyelitis. Plast Reconstr Surg 2016;137:394e-404e. https://doi.org/10.1097/01.prs.0000475770.14396.1e
  17. Annan M, de Toffol B, Hommet C, Mondon K. Sinking skin flap syndrome (or syndrome of the trephined): a review. Br J Neurosurg 2015;29:314-8. https://doi.org/10.3109/02688697.2015.1012047
  18. Ashayeri K, Jackson EM, Huang J, Brem H, Gordon CR. Syndrome of the trephined: a systematic review. Neurosurgery 2016;79:525-34. https://doi.org/10.1227/NEU.0000000000001366