New Technique of Decompressive Skinplasty With Artificial Dermis for Severe Brain Swelling

Abstract

In cases of severe uncontrollable brain swelling, simple skin closure often increases intracranial pressure. This study examined the efficacy of a new technique of decompressive skinplasty to decrease intracranial pressure following decompressive craniectomy in cases of severe traumatic brain injury with uncontrollable brain swelling. In our technique, we use artificial dermis to avoid elevation of intracranial pressure. After performing decompressive craniectomy and duraplasty with artificial dura, decompressive skinplasty with artificial dermis was performed in 5 patients for whom simple skin closure caused the intracranial pressure to elevate under intracranial pressure monitoring. Artificial dermis was grafted onto the region to cover the skin defect and sutured to the skin with 4-0 nylon sutures. Two weeks after surgery, the silicone layer of the artificial dermis was removed and ointment treatment was continued until complete epithelialization was achieved. In all cases, decompressive skinplasty contributed dramatically to decreasing the intracranial pressure in patients with uncontrollable brain swelling. The technique of decompressive skinplasty with artificial dermis contributed to dramatically decreasing the intracranial pressure. More cases are required to investigate the indications for this technique.

Decompressive Bone Flap Replacement (Decompressive Cranioplasty): A Novel Technique for Intracranial Hypertension—Initial Experience and Outcome

“…technique significantly decreases ICP but requires a long period and extra effort for wound care 26 . In 2015, a dynamic decompressive craniotomy technique using a novel cranial fixation plate with a telescopic component was proposed.…”

“…This technique significantly decreases ICP but requires a long period and extra effort for wound care. 26 In 2015, a dynamic decompressive craniotomy technique using a novel cranial fixation plate with a telescopic component was proposed. This technique showed better control of ICP in a cadaver study compared with standard craniotomy and hinge craniectomy.…”

Decompressive Surgery for Traumatic Intracranial Hypertension

“…We previously reported the usefulness of decompressive skinplasty with an artificial dermis in decompressive craniectomy for the management of severe TBI with uncontrollable brain swelling [7]. Although this technique contributed to dramatically decreasing ICP, the Glasgow Outcome Scale score was unchanged at discharge.…”