Vacuum-assisted closure for complex cranial wounds involving the loss of dura mater

Abstract

The aim in this study was to describe the safety and efficacy of vacuum-assisted closure (VAC) in patients with complex cranial wounds with extensive scalp, bone, and dural defects who were not candidates for immediate free tissue transfer. Five patients (4 men and 1 woman) ages 24-73 years with complex cranial wounds were treated with VAC at Wake Forest Baptist Medical Center. Etiologies included trauma, squamous cell carcinoma, and malignant meningioma. Cutaneous wound defects measured as large as 15 cm in diameter. Four of the 5 patients had open skull defects with concomitant dural defects, and 1 patient had dural dehiscence. After surgical debridement, all 5 patients were treated with the direct application of a VAC device to a reapproximated dura mater (1 patient), to a pericranial flap (1 patient), or to a regenerative tissue matrix overlying CNS tissue (3 patients). In all cases involving open cranial wounds, the VAC device promoted granulation tissue formation over the dural substitute, prevented CSF leakage, and kept the wounds free from local infection. The duration of VAC therapy ranged from 16 to 91 days. Although VAC therapy was intended as a temporary measure until these patients could be stabilized for larger tissue transfer procedures or they succumbed to their primary pathology, 1 patient had a successful skin graft following VAC therapy. Hydrocephalus requiring shunt placement developed in 2 patients during VAC therapy. The VAC dressings applied to a tissue matrix or other barrier over brain tissue in extensive cranial wounds are safe and well tolerated, providing a functional barrier and preventing infection.

Negative Pressure Wound Therapy in the Head and Neck: An Evidence‐Based Approach

“…Nonetheless, of the 49 cases of irradiated patients for which we had a definitive response rate, all but 13 had successful closure with NPWT. Of the 13 cases that were unsuccessful, there were six cases of fistula formation, two cases of pharyngostome with delayed closure, two cases of graft failure, one case each of subsequent closure with a flap or split thickness graft, and a case with secondary closure …”

“…Of the 13 cases that were unsuccessful, there were six cases of fistula formation, two cases of pharyngostome with delayed closure, two cases of graft failure, one case each of subsequent closure with a flap or split thickness graft, and a case with secondary closure. 6,13,[15][16][17][18][19] For nonirradiated patients, we were able to use 248 of the 437 cases without reported data on prior radiation exposure. We had to exclude 189 cases because they did not separate response rates between the two populations or did not report response rates.…”

Vacuum-Assisted Closure Device and Skin Substitutes for Complex Mohs Defects

“…Although 2 select cases were presented in this article, the use of the VAC has been demonstrated over exposed parotid and even dura mater, indicating its versatility and potential applications to wounds created in any anatomic location. 16,17 If planned appropriately, all procedures may be performed as an outpatient mitigating some of the costs of the Integra. Furthermore, by providing a stable soft tissue reconstruction, the need for revision procedures to deal with subsequent problems and complications is minimized.…”

Dural repair using porcine ADM: two cases and a literature review

“…The use of vacuum therapy is shown to significantly increase blood flow and decrease the rate of infection in the treated area [16]. It can be hypothesized that combining vacuum therapy with implantation of an ADM would decrease the incorporative process in a time perspective, due to higher infiltration rate.…”