Hofmann L, Rafizadeh Rashid M, Ludtka C, Schwan S, Mendel T, Sanchin L, Goehre F. Calvarial Reconstruction Following Massive Tissue Loss: A Feasible Treatment Strategy and Surgical Technique.
Oper Neurosurg (Hagerstown) 2021;
20:317-322. [PMID:
33294937 DOI:
10.1093/ons/opaa371]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 09/06/2020] [Indexed: 11/14/2022] Open
Abstract
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.
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