Single stage reconstruction of scalp and skull using free muscle flap and titanium mesh in patients with epidural infection

Yoshioka, Nobutaka; Haraoka, Goichi; Muraoka, Michinari; Tominaga, Shinsuke

doi:10.1016/s1010-5182(96)80023-0

Cited by 19 publications

(12 citation statements)

References 18 publications

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“…Another option is to use a combined LD and serratus anterior muscle flap to sandwich the implant. 31,32 Immediate cranial reconstruction is especially advantageous for patients with VP shunts since their skin flaps are likely to shrink due to atmospheric pressure, which can contribute to the development of syndrome of the trephined. 26,27 …”

Section: Discussionmentioning

confidence: 99%

Versatility of the Latissimus Dorsi Free Flap during the Treatment of Complex Postcraniotomy Surgical Site Infections

Yoshioka

2017

Plastic and Reconstructive Surgery - Global Open

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Background:Some intractable cases of postcraniotomy infection, which can involve compromised skin, an open frontal air sinus, and residual epidural dead space, have been reported. In such cases, reconstructing the scalp and skull is challenging.Methods:Between 2009 and 2016, the author treated 12 patients with recalcitrant postcraniotomy surgical site infections with latissimus dorsi (LD) free flaps. The patients’ ages ranged from 37 to 79 years (mean, 63.5 years), and their underlying diseases included subarachnoid hemorrhaging (n = 5), brain tumors (n = 4), and cerebral arteriovenous malformations (n = 3).Results:The LD free flap was used for scalp reconstruction in 3 cases, scalp reconstruction and separation of the intracranial and nasal cavities in 5 cases, and the obliteration of epidural dead space in 4 cases. Debridement followed by staged cranial reconstruction was carried out in 8 cases, and single-stage cranial reconstruction was conducted in 2 cases. The bone defects of the other 2 cases, which were small, were filled with LD musculo-adipose free flaps. The postoperative local appearance of the wounds was acceptable in every case, and no complications occurred.Conclusions:The LD free flap is a versatile tool for the treatment of complex postcraniotomy surgical site infections. This vascularized muscle flap is useful for controlling local infections because of its abundant vascularity. Moreover, its variety of uses means that it can resolve several problems in cases involving complex cranial wounds.

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Section: Discussionmentioning

confidence: 99%

Versatility of the Latissimus Dorsi Free Flap during the Treatment of Complex Postcraniotomy Surgical Site Infections

Yoshioka

2017

Plastic and Reconstructive Surgery - Global Open

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“…6,9 Other methods for repair of scalp defects have used free muscle flaps 17,18 and artificial dermis. 19 Titanium has been described for the reconstruction of other types of skull defects, 10,11 Here we present an alternative method, using titanium mesh with underlying autologous adipose tissue for successful repair of temporal fossa defects with good long-term outcomes in two patients.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9] The use of titanium mesh for reconstruction of skull defects has been described in the literature. 10,11 Here we present a novel and simple technique using titanium mesh shaped to mimic the natural contour of the scalp, along with implantation of autologous abdominal adipose tissue to obliterate the potential dead space.…”

mentioning

confidence: 99%

Titanium Mesh Reconstruction to Maintain Scalp Contour after Temporalis Musculofascial Flap Reconstruction of the Floor of the Middle Cranial Fossa: A Technical Note and Report of Two Cases

et al. 2009

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Objective: Temporalis musculofascial rotational flaps can provide excellent tissue for reconstruction of defects in the floor of the middle cranial fossa. This technique can, however, result in cosmetic deformity of the temporal fossa with an asymmetric contour of the head. We report a technique that uses titanium mesh and autologous abdominal adipose to maintain a normal scalp contour. Clinical Presentation: Two patients, one with a large middle cranial fossa and infratemporal schwannoma, and another with penetrating trauma secondary to a rifle accident, required surgical repair of defects of the floor of the middle cranial fossa. Intervention: The repair was achieved in both cases using a temporalis musculofascial rotational flap. Normal contour of the scalp was maintained with titanium mesh and autologous abdominal adipose reconstruction. Conclusion: The temporalis musculofascial flap, combined with titanium mesh and autologous adipose reconstruction, provided excellent closure of defects of the floor of the middle cranial fossa while preserving normal cosmetic scalp contour.

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“…F or a large cranial bone defect after extirpation of a skull base tumor, a titanium mesh is often used as an artificial material for the structural cranial bone reconstruction. [1][2][3] In clinical practice, titanium mesh has some notable advantages, that is, it is easy to prepare and handle, it has no donor site morbidity, and it can shorten the operative time because it does not need harvesting procedures. However, on the other hand, there are disadvantages that cannot be ignored, namely, the risk of postoperative infection and exposure of the titanium mesh.…”

Section: The Flap Sandwich Technique For a Safe And Aesthetic Skull Bmentioning

confidence: 99%

“…1,6,7 Furthermore, there have been no reports addressing reconstructive procedures that could provide both structural and aesthetical cranial bone reconstruction combined with skull base surgery.…”

Section: The Flap Sandwich Technique For a Safe And Aesthetic Skull Bmentioning

confidence: 99%

The Flap Sandwich Technique for a Safe and Aesthetic Skull Base Reconstruction

Yano

Okazaki²,

Tanaka³

et al. 2016

Annals of Plastic Surgery

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For safe and reliable skull base reconstruction combined with repair of cranial bone defects, we introduce the flap sandwich technique in this study. A titanium mesh is often used to repair structural cranial bone defects because it has less donor site morbidity and is easy to handle. However, titanium mesh has disadvantages of exposure and infection postoperatively. To improve surgical outcomes, we applied the flap sandwich technique to 3 cases of skull base reconstruction combined with cranial bone defect repair. Two anterior skull base defects and 1 middle skull base defect were included in this study. The subjects were all women, aged 30, 58, and 62 years. One patient had former multiple craniotomies and another patient had preoperative radiotherapy. The flap sandwich technique involves structural cranial bone reconstruction with a titanium mesh and soft tissue reconstruction with a chimeric anterolateral thigh free flap. First, the dead space between the repaired dura and the titanium mesh is filled with vastus lateralis muscle, and then structural reconstruction is performed with a titanium mesh. Finally, the titanium mesh is totally covered with the adiposal flap of the anterolateral thigh free flap. The muscle flap protects the dead space from infection, and the adiposal flap covers the titanium mesh to reduce mechanical stress on the covered skin and thus prevent the exposure of the titanium mesh through the scalp. By applying this technique, there was no intracranial infection or titanium mesh exposure in these 3 cases postoperatively, even though 2 patients had postoperative radiotherapy. Additionally, the adiposal flap could provide a soft and natural contour to the scalp and forehead region, and this gives patients a better facial appearance even though they have had skull base surgery.

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Single stage reconstruction of scalp and skull using free muscle flap and titanium mesh in patients with epidural infection

Cited by 19 publications

References 18 publications

Versatility of the Latissimus Dorsi Free Flap during the Treatment of Complex Postcraniotomy Surgical Site Infections

Versatility of the Latissimus Dorsi Free Flap during the Treatment of Complex Postcraniotomy Surgical Site Infections

Titanium Mesh Reconstruction to Maintain Scalp Contour after Temporalis Musculofascial Flap Reconstruction of the Floor of the Middle Cranial Fossa: A Technical Note and Report of Two Cases

The Flap Sandwich Technique for a Safe and Aesthetic Skull Base Reconstruction

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