Calvarial Reconstruction Following Massive Tissue Loss: A Feasible Treatment Strategy and Surgical Technique.
Autologous split-rib transplantation
Calvarial reconstruction
Cranial electrical burn
Full-thickness tissue loss
Scalp injury
Skull reconstruction
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
16 02 2021
16 02 2021
Historique:
received:
09
02
2020
accepted:
06
09
2020
pubmed:
10
12
2020
medline:
22
6
2021
entrez:
9
12
2020
Statut:
ppublish
Résumé
Severe cranial injuries require reconstructive surgeries to protect the underlying brain and to restore cranial contour and scalp integrity, as well as avoid complications such as neurocognitive decline. In cases of full-thickness cranial tissue damage, adept surgical skill in both bone and soft tissue reconstruction is critical for a minimally invasive surgery and successful bone integration without endangering previous soft tissue efforts. Different surgical techniques and materials are beset with various problems. To present a surgical procedure intended for the reconstruction of complex calvarial and associated tissue defects with reduced invasiveness and improved soft tissue healing compared to the existing gold standard. Both soft tissue and bone reconstruction techniques are described in detail due to their intertwined importance for successful full thickness skull and scalp reconstruction. During initial medical care, aseptic wound treatment and temporary wound closure are performed. Two weeks postinjury, extensive necrotic tissue debridement and soft tissue reconstruction lay the foundation for well-vascularized tissue regeneration. Soft tissue healing is followed by minimally invasive cranioplasty using autologous split-rib transplants after approximately 6 mo. With consideration of the established gold standards for treatment, soft tissue regenerated without complications. The minimally invasive insertion of autologous rib grafts underneath the healed soft tissue allowed for quick recovery without requiring further follow-up treatments. We optimized initial scalp wound healing and bone regeneration by making use of minimally invasive procedures and autologous materials, offering a viable treatment alternative to existing methods for treating large cranial bone injuries.
Sections du résumé
BACKGROUND
Severe cranial injuries require reconstructive surgeries to protect the underlying brain and to restore cranial contour and scalp integrity, as well as avoid complications such as neurocognitive decline. In cases of full-thickness cranial tissue damage, adept surgical skill in both bone and soft tissue reconstruction is critical for a minimally invasive surgery and successful bone integration without endangering previous soft tissue efforts. Different surgical techniques and materials are beset with various problems.
OBJECTIVE
To present a surgical procedure intended for the reconstruction of complex calvarial and associated tissue defects with reduced invasiveness and improved soft tissue healing compared to the existing gold standard. Both soft tissue and bone reconstruction techniques are described in detail due to their intertwined importance for successful full thickness skull and scalp reconstruction.
METHODS
During initial medical care, aseptic wound treatment and temporary wound closure are performed. Two weeks postinjury, extensive necrotic tissue debridement and soft tissue reconstruction lay the foundation for well-vascularized tissue regeneration. Soft tissue healing is followed by minimally invasive cranioplasty using autologous split-rib transplants after approximately 6 mo.
RESULTS
With consideration of the established gold standards for treatment, soft tissue regenerated without complications. The minimally invasive insertion of autologous rib grafts underneath the healed soft tissue allowed for quick recovery without requiring further follow-up treatments.
CONCLUSION
We optimized initial scalp wound healing and bone regeneration by making use of minimally invasive procedures and autologous materials, offering a viable treatment alternative to existing methods for treating large cranial bone injuries.
Identifiants
pubmed: 33294937
pii: 6027920
doi: 10.1093/ons/opaa371
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
317-322Informations de copyright
Copyright © 2020 by the Congress of Neurological Surgeons.