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Baghaki S, Yalcin CE, Mazlum LC. Periosteal Turnover Flap for Coverage and Salvage of Exposed Deep Brain Stimulation Device. J Craniofac Surg 2023; 34:e794-e796. [PMID: 38011272 DOI: 10.1097/scs.0000000000009683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/25/2023] [Indexed: 11/29/2023] Open
Abstract
Implanted deep brain stimulation (DBS) devices are crucial in the treatment of movement disorders. Hardware extrusion is among the most frequent complications of the implantation process and requires reconstruction with well-vascularized tissues. The authors present a case of periosteal turnover flap for coverage of an exposed DBS device. An 11-year-old female patient with spastic cerebral palsy presented with an exposed DBS device located in the right parietal area. The exposed device was covered by a proximally based periosteal flap. Postoperative evaluations at months 1, 2, 3, and 8 revealed no signs of infection or dehiscence. This brief clinical study shows that reconstruction with periosteal turnover flaps is both an easy and excellent choice for secondary closure of exposed DBS devices.
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Affiliation(s)
- Semih Baghaki
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Koc University School of Medicine
| | - Can E Yalcin
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Leo C Mazlum
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Koc University School of Medicine
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Chang KW, Zhong LM, Lee DS, Puram SV, Jackson RS, Yaeger LH, Pipkorn P. Outcomes of Mesh Cranioplasty in Scalp-Free Tissue Reconstruction: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:970-978. [PMID: 36939541 DOI: 10.1002/ohn.199] [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: 08/01/2022] [Revised: 10/12/2022] [Accepted: 10/23/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To systematically review the literature to determine the prevalence and risk of the free flap and postoperative complications in scalp-free tissue reconstruction with synthetic mesh cranioplasty. DATA SOURCES Search strategies created with a medical librarian were implemented using multiple databases in May 2021. REVIEW METHODS Two reviewers independently performed the review, data extraction, and quality assessment. Cohort studies of patients with scalp-free tissue reconstruction with or without mesh cranioplasty were included. Studies that did not report whether mesh was used or did not separate outcomes by mesh use were excluded. The primary outcomes were free flap failure and postoperative complications. A random-effects model was used for the meta-analysis to estimate prevalence and prevalence ratios (PRs). RESULTS A total of 28 studies and 440 cases of scalp-free tissue reconstruction were included. The pooled prevalence of free flap failures and postoperative complications in patients with mesh cranioplasty was estimated at 7% (95% confidence interval [CI], 3%-17%; p = .85, I2 = 0%) and 21% (95% CI, 14%-31%; p = .44, I2 = 0%), respectively. In a subgroup analysis, mesh cranioplasty was not associated with a significantly increased risk of free flap failure or postoperative complications when compared to cases without mesh cranioplasty; pooled PR 1.21 (95% CI, 0.50-2.88; p = .90, I2 = 0%) for free flap failure and PR 1.85 (95% CI, 0.89-3.85; p = .28, I2 = 19) for postoperative complications. CONCLUSION Synthetic mesh cranioplasty does not significantly increase the risk of free flap compromise or postoperative complications. A higher prevalence of postoperative recipient site complications was observed in patients with mesh cranioplasty.
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Affiliation(s)
- Katherine W Chang
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Lydia M Zhong
- Washington University School of Medicine, St Louis, Missouri, USA
| | - David S Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA.,Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Lauren H Yaeger
- Bernard Becker Medical Library, Washington University School of Medicine, St Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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Hardware-Related Skin Erosion in Deep Brain Stimulation for Parkinson's Disease: How Far Can We Go? An Illustrative Case Report. Brain Sci 2022; 12:brainsci12121715. [PMID: 36552174 PMCID: PMC9775376 DOI: 10.3390/brainsci12121715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Skin erosion is a hardware-related complication commonly described after deep brain stimulation (DBS). Hardware exposure is often associated with the development of infection that can lead to implant removal. However, in selected cases, it is possible to manage skin erosion without having to remove the hardware. This article presents the case of a patient with recurrent skin erosions above the IPG, who underwent multiple surgeries. Given the failure of less invasive approaches, a more complex surgery with the employment of a pedunculated flap of pectoralis major in order to cover the IPG was attempted. Nevertheless, the IPG removal was finally unavoidable, resulting in a rapid decline in clinical performance. This illustrative case suggests how, in patients with sustained stimulation who benefit from a good degree of autonomy, it may be useful to use invasive surgical techniques to resolve skin erosions and save the DBS system. In spite of everything, sometimes complete or partial removal of the implant still becomes unavoidable, but this can lead to a severe worsening of PD symptoms. Definitive removal of the system should therefore be considered only in cases of frank infection or after failure of all other approaches.
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Saving the Exposed Deep Brain Stimulation Implant: A Comprehensive Review of Implant Extrusion and Reconstructive Options. Ann Plast Surg 2022; 89:e21-e30. [DOI: 10.1097/sap.0000000000003318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Oh BH, Park YY, Park JK, Park YS. Vacuum-Assisted Closure with Temporalis Muscle Reconstruction for Recurrent Scalp Erosion Following Deep Brain Stimulation: A Case Report. JOURNAL OF PARKINSONS DISEASE 2021; 11:1465-1469. [PMID: 33843699 DOI: 10.3233/jpd-212651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Scalp erosion is not an uncommon complication of deep brain stimulation (DBS) surgery. Although various methods have been proposed to prevent and manage complications, there are still challenges. We introduce a case of recurrent scalp erosion after DBS surgery treated with vacuum-assisted closure. CASE DESCRIPTION This article reports the case of a patient who underwent DBS for advanced Parkinson's disease and suffered from recurrent scalp erosion with device extrusion through the skin. Scalp erosion occurred 2 years after DBS and repeated improvement and deterioration despite scalp reconstruction using a skin flap. We opened the wound and performed temporal muscle reconstruction to cover the burr hole site, and we changed the exposed cable and applied vacuum-assisted closure. During the follow-up period, no signs of erosion or infection occurred, and DBS efficacy was preserved. CONCLUSION To date, the available management strategies for scalp erosion after DBS are revision with debridement and scalp reconstruction using skin flaps or skin grafts. However, if erosion occurs repeatedly despite the above management strategies, vacuum-assisted closure with temporalis muscle reconstruction could be a suitable option. We suggest that if the condition of the scalp is weakened, it is worth considering this approach preferentially.
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Affiliation(s)
- Byeong Ho Oh
- Department of Neuroscience, Graduate School, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.,Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Yoon Young Park
- Department of Neuroscience, Graduate School, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.,Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Ji Kang Park
- Department of Orthopedic Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Young Seok Park
- Department of Neuroscience, Graduate School, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.,Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Department of Neurosurgery, Gamma Knife Icon Center, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Institute for Stem Cell & Regenerative Medicine (ISCRM), Chungbuk National University, Cheongju, Republic of Korea
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Britz JPE, Franceschini PR, Ramos MB, de Aguiar PHP, Farah JO, de Aguiar PHP. Skin erosion in deep brain stimulation procedures: Using the temporalis muscle to treat this complication - A technical note. Surg Neurol Int 2021; 12:355. [PMID: 34345495 PMCID: PMC8326058 DOI: 10.25259/sni_372_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Skin erosion is a common complication after deep brain stimulator procedures. Despite being a relatively common event, there is no standard surgical technique or a widely accepted guideline for managing this kind of complication. Methods: We describe a case of cutaneous erosion in the connector’s site of deep brain stimulation case, surgically managed with anterior displacement of the connectors and overlapping and wrapping the connections within the temporal muscle. Results: Postoperatively, the patient did well and achieved complete resolution of the skin erosion, with no signs of infection or new skin lesions. Conclusion: This technique demonstrated to be effective in this case in the long-term follow-up.
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Affiliation(s)
- João Pedro Einsfeld Britz
- Department of Health Science, Medical School, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Paulo Roberto Franceschini
- Department of Neurology and Neurosurgery, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Miguel Bertelli Ramos
- Department of Health Science, Medical School, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | | | - Jibril Osman Farah
- Department of Neurosurgery, The Walton Centre, Liverpool, United Kingdom
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Tao R, Xue C, Yang C, Simfukwe K, Hu X, Wu X, Bi H. Reconstruction of chronic scalp erosion after deep brain stimulation surgery. J Plast Reconstr Aesthet Surg 2020; 74:1807-1813. [PMID: 33358678 DOI: 10.1016/j.bjps.2020.11.045] [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: 08/04/2019] [Revised: 08/26/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the reconstructive effectiveness for chronic scalp erosion after deep brain stimulation (DBS). BACKGROUND Deep brain stimulation (DBS) is an effective treatment for Parkinson's disease. However, this surgery is not exempt from hard-ware related complications, especially scalp erosions on scalp. Scalp erosions usually accompanied with chronic infection and wound contamination. If not arrested, infections may spread through the entire equipment which would endanger the patient's life. Along with review of previous literatures, we summarized our experience in the management of scalp erosion and implemented a systemic treatment plan for reconstruction. METHODS We retrospectively analyzed the clinical data of patients with chronic scalp erosion after DBS in the past 40 months. The treatment plan was composed of three sequential major steps, including wound care and conservative methods, debridement and local flap, and revaluation of the wound. In each of the cases, wound debridement and local scalp flap repair were conducted, and assisted by negative pressure wound therapy (NPWT) device and double cannula irrigation. RESULTS The local scalp flap survived in all 6 patients. The chronic scalp erosions all healed without refractory. The DBS devices still functioned properly after the treatments in all patients. The average follow-up period was 13.33 months (range: 4 to 23 months), and no infection recurrence or re-erosion of the scalp flap was reported. CONCLUSION A combination of wound debridement, local scalp flap repair, the use of NPWT device and double cannula irrigation provides effective treatment method for chronic erosion post DBS surgery.
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Affiliation(s)
- Ran Tao
- Department of Plastic Surgery, Changhai Hospital,Second Military Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Chunyu Xue
- Department of Plastic Surgery, Changhai Hospital,Second Military Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Chunhui Yang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Keith Simfukwe
- Department of Neurosurgery, Mordovia Republican Clinical Hospital, Pobedi Street, Saransk, Mordovia, Russia
| | - Xiaowu Hu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Xi Wu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China.
| | - Hongda Bi
- Department of Plastic Surgery, Changhai Hospital,Second Military Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China.
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Staudt MD, Pourtaheri N, Lakin GE, Soltanian HT, Miller JP. Surgical Management of Deep Brain Stimulator Scalp Erosion without Hardware Removal. Stereotact Funct Neurosurg 2017; 95:385-391. [PMID: 29232685 DOI: 10.1159/000484323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/16/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Scalp erosion in patients with deep brain stimulation (DBS) hardware is an uncommon complication that lacks a clearly defined management strategy. Previous studies have described various therapies including conservative treatment with antibiotics and surgical debridement with or without hardware removal. OBJECTIVES The aim of this study was to review the efficacy of a hardware-sparing management strategy for the treatment of scalp erosion. METHODS Five patients with previous DBS implantation presented with scalp erosion and visible hardware exposure at the calvarial burr hole site, and underwent tension-free, vascularized, rotational scalp flap, with preservation of the leads under the pericranium. Two of the procedures were performed after an unsuccessful attempt at primary closure and 3 as a primary procedure. Each patient was followed clinically for at least 14 months postoperatively to evaluate for wound-healing and adverse effects. RESULTS The median duration from initial DBS hardware implantation to erosion and revision surgery was 12 months (range 1.5-62 months). Three patients were documented to have positive intraoperative cultures in spite of the absence of purulence. At the last follow-up, all patients were noted to have complete wound-healing and no evidence of infection or erosion. CONCLUSIONS DBS scalp erosion can be managed by rotational scalp flap without hardware removal, even in cases where infection is identified.
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Affiliation(s)
- Michael D Staudt
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Skorvanek M, Bhatia KP. The Skin and Parkinson's Disease: Review of Clinical, Diagnostic, and Therapeutic Issues. Mov Disord Clin Pract 2017; 4:21-31. [PMID: 30363435 PMCID: PMC6174479 DOI: 10.1002/mdc3.12425] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) and the skin are related in a number of ways, including clinical abnormalities of the disease itself and skin-related side effects of dopaminergic medication, pumps, and surgical therapies. Recent advances in understanding the role of α-synuclein suggest skin biopsies as a potential diagnostic or even a premotor marker of PD. METHODS The PubMed database was searched for publications up to October 2015, and the current evidence on skin-related issues in PD was comprehensively summarized. RESULTS The evidence was summarized on the prevalence, etiology, and management of seborrheic dermatitis, sweating dysfunctions, bullous pemphigoid, and malignant melanoma, as well as therapy-related skin disorders, especially those observed in amantadine, rotigotine, apomorphine, and levodopa/carbidopa intestinal gel therapies and deep-brain stimulation. Skin biopsies evaluating the presence of α-synuclein, the density and morphology of cutaneous nerves, and skin fibroblast functions also are discussed. CONCLUSIONS Skin disorders are a common manifestation of PD. However, the exact pathophysiology and prevalence of these disorders are not well understood, and more systematic research is needed in this regard. Peripheral tissue biopsies as a diagnostic marker of PD are an exciting avenue in future PD research, although multiple caveats and pending issues need to be solved before they can be used in routine clinical practice.
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Affiliation(s)
- Matej Skorvanek
- Department of NeurologyP. J. Safarik UniversityKosiceSlovakia
- Department of NeurologyUniversity Hospital L. PasteurKosiceSlovakia
| | - Kailash P. Bhatia
- Sobell Department of Motor Neuroscience and Movement DisordersUCL Institute of NeurologyUniversity College LondonLondonUnited Kingdom
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