Accelerated Cranioplasty with Perforator-preserved Split Flap Sandwiched Plate for Treatment of Infected Cranial Defects
Summary:. Large cranial vault defects are challenging to manage due to the need to balance infection control, skin coverage, and restoration of the protective mechanical rigidity of the skull while also ensuring good head and neck aesthetic results. Conventional-staged treatment requires a long time...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-04-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004234 |
| _version_ | 1818522740089421824 |
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| author | Yoshimoto Okada, MD Mitsunaga Narushima, MD, PhD Chihena H. Banda, MD Kanako Danno, MD Kohei Mitsui, MD Makoto Shiraishi, MD Masato Shiba, MD, PhD Yume Suzuki, MD Ryohei Ishiura, MD |
| author_facet | Yoshimoto Okada, MD Mitsunaga Narushima, MD, PhD Chihena H. Banda, MD Kanako Danno, MD Kohei Mitsui, MD Makoto Shiraishi, MD Masato Shiba, MD, PhD Yume Suzuki, MD Ryohei Ishiura, MD |
| author_sort | Yoshimoto Okada, MD |
| collection | DOAJ |
| description | Summary:. Large cranial vault defects are challenging to manage due to the need to balance infection control, skin coverage, and restoration of the protective mechanical rigidity of the skull while also ensuring good head and neck aesthetic results. Conventional-staged treatment requires a long time period that includes debridement and scalp skin defect coverage with flaps as a first step, followed by definitive plate reconstruction 3–9 months later after infection control and flap atrophy resolution. We report a case of successful early cranioplasty in a factory worker who developed a large full-thickness cranial skull defect following artificial dura infection. Reconstruction was performed in two stages using an anterolateral thigh (ALT) flap. In the first stage, the scalp defect was covered with an ALT flap to close the skin following debridement. In the second stage performed 6 weeks later, the ALT flap was split into adiposal and adipocutaneous flaps to sandwich a computer-aided design custom-made titanium plate with an opening for the perforator to complete the cranioplasty. The patient successfully returned to work without recurrence of infection with 1-year follow-up. We report this case to demonstrate the utility of adipocutaneous flap plate sandwiching techniques in providing well-vascularized cover for early definitive cranial reconstruction and accelerated patient recovery. |
| first_indexed | 2024-12-11T05:37:02Z |
| format | Article |
| id | doaj.art-5fd86193b6bb42ecb53c710be6e18655 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-11T05:37:02Z |
| publishDate | 2022-04-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-5fd86193b6bb42ecb53c710be6e186552022-12-22T01:19:15ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742022-04-01104e423410.1097/GOX.0000000000004234202204000-00005Accelerated Cranioplasty with Perforator-preserved Split Flap Sandwiched Plate for Treatment of Infected Cranial DefectsYoshimoto Okada, MD0Mitsunaga Narushima, MD, PhD1Chihena H. Banda, MD2Kanako Danno, MD3Kohei Mitsui, MD4Makoto Shiraishi, MD5Masato Shiba, MD, PhD6Yume Suzuki, MD7Ryohei Ishiura, MD8From the * Department of Plastic and Reconstructive Surgery, Mie University, Tsu, JapanFrom the * Department of Plastic and Reconstructive Surgery, Mie University, Tsu, JapanFrom the * Department of Plastic and Reconstructive Surgery, Mie University, Tsu, JapanFrom the * Department of Plastic and Reconstructive Surgery, Mie University, Tsu, JapanFrom the * Department of Plastic and Reconstructive Surgery, Mie University, Tsu, JapanFrom the * Department of Plastic and Reconstructive Surgery, Mie University, Tsu, Japan† Department of Neurosurgery, Mie University, Tsu, Japan.† Department of Neurosurgery, Mie University, Tsu, Japan.From the * Department of Plastic and Reconstructive Surgery, Mie University, Tsu, JapanSummary:. Large cranial vault defects are challenging to manage due to the need to balance infection control, skin coverage, and restoration of the protective mechanical rigidity of the skull while also ensuring good head and neck aesthetic results. Conventional-staged treatment requires a long time period that includes debridement and scalp skin defect coverage with flaps as a first step, followed by definitive plate reconstruction 3–9 months later after infection control and flap atrophy resolution. We report a case of successful early cranioplasty in a factory worker who developed a large full-thickness cranial skull defect following artificial dura infection. Reconstruction was performed in two stages using an anterolateral thigh (ALT) flap. In the first stage, the scalp defect was covered with an ALT flap to close the skin following debridement. In the second stage performed 6 weeks later, the ALT flap was split into adiposal and adipocutaneous flaps to sandwich a computer-aided design custom-made titanium plate with an opening for the perforator to complete the cranioplasty. The patient successfully returned to work without recurrence of infection with 1-year follow-up. We report this case to demonstrate the utility of adipocutaneous flap plate sandwiching techniques in providing well-vascularized cover for early definitive cranial reconstruction and accelerated patient recovery.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004234 |
| spellingShingle | Yoshimoto Okada, MD Mitsunaga Narushima, MD, PhD Chihena H. Banda, MD Kanako Danno, MD Kohei Mitsui, MD Makoto Shiraishi, MD Masato Shiba, MD, PhD Yume Suzuki, MD Ryohei Ishiura, MD Accelerated Cranioplasty with Perforator-preserved Split Flap Sandwiched Plate for Treatment of Infected Cranial Defects Plastic and Reconstructive Surgery, Global Open |
| title | Accelerated Cranioplasty with Perforator-preserved Split Flap Sandwiched Plate for Treatment of Infected Cranial Defects |
| title_full | Accelerated Cranioplasty with Perforator-preserved Split Flap Sandwiched Plate for Treatment of Infected Cranial Defects |
| title_fullStr | Accelerated Cranioplasty with Perforator-preserved Split Flap Sandwiched Plate for Treatment of Infected Cranial Defects |
| title_full_unstemmed | Accelerated Cranioplasty with Perforator-preserved Split Flap Sandwiched Plate for Treatment of Infected Cranial Defects |
| title_short | Accelerated Cranioplasty with Perforator-preserved Split Flap Sandwiched Plate for Treatment of Infected Cranial Defects |
| title_sort | accelerated cranioplasty with perforator preserved split flap sandwiched plate for treatment of infected cranial defects |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004234 |
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