Soft tissue coverage of cranial defects: an update

Abstract

Scalp and cranial defects can occur as a result of cutaneous or bony malignancies, trauma, or surgical intervention for intracranial tumors. Soft tissue cranial reconstruction of composite defects presents a unique challenge given the relative tissue inelasticity of the scalp, need for tension free closure, and convex shape of the cranium. An added complexity is found in patients with large defects, cerebrospinal fluid leak, prior failed reconstruction, infection, or previous radiation. Methods and materials for skull reconstruction have evolved significantly over the years, allowing surgeons to repair even the most challenging composite defects with excellent success rates. This review aims to discuss and evaluate the available soft tissue options for cranioplasty coverage, with particular focus on hostile reconstructive fields and the use of free tissue transfer.

Cost differences between autologous and nonautologous cranioplasty implants: A propensity score–matched value driven outcomes analysis

“… 9 , 10 Although they are more expensive than autologous bone grafts, custom implants ideally offer multiple advantages, including faster operating times (because they are prefabricated and require no bone retrieval operations or bone preparation), alleviation of bone flap storage complexities, no potential for bone flap resorption, reduced postoperative infection rates, and a more precise fit, which reduces the likelihood of imbalanced skin pressures with resultant skin breakdown. 6 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 These benefits suggest that custom implants could supersede autologous implants as the new gold standard. To this end, a limited number of studies have examined whether the increased initial costs of a custom cranioplasty can be economically justified by reducing the long-term complications, and thus total costs, more commonly observed among autologous grafts.…”

Systematic Review of Syndrome of the Trephined and Reconstructive Implications

“…Appropriate soft tissue coverage of the cranioplasty is paramount 53. At the bottom of the reconstructive ladder is secondary intention, an option only if the defect is limited to soft tissue which is rarely the case for cranioplasty patients.…”

Biomaterials for Regenerative Cranioplasty: Current State of Clinical Application and Future Challenges

“…Besides the abovementioned drawbacks, most of these materials fail to properly interact with surrounding soft tissues, i.e., the scalp and temporalis muscle. For instance, the soft tissue coverage typically failed due to dehiscence at the implant-soft tissue interface as well as the colonisation of microbes, leading to disappointing cranioplasty [18][19][20]. There remains an imminent need to develop materials that can effectively repair cranial defects without raising safety concerns, causing discomfort, introducing artefacts in post-operative imaging, and interacting with the surrounding soft tissue in a desired way.…”