Assessment of Skin Flaps Above Cranial Defects Following Craniectomy: A Proposed Classification System

Abstract

Objective The assessment of the skin flap above cranial defects (SCD) following craniectomy is routine in neurosurgical practice, and a change in the consistency of the skin flap may indicate raised intracranial pressure or the occurrence of a complication necessitating intervention. The purpose of this study was to develop a clinically useful classification system based on clinical assessment of the degree of skin flap bulging or sinking and its firmness. Patients and Methods This was a prospective single-center study. The SCDs of consecutive patients who underwent craniectomy were assessed daily by two trained independent examiners. The consistency of the flap and its bulging or sinking in comparison with the level of the cranium were noted. Testing conditions including the positioning of the patient and examiner were standardized. Results A total of 520 examinations were conducted in 24 patients during their hospital stay. There was 100% interrater reliability (Cohen’s κ = 1.0). In 66.6% of all patients (n = 16/24), a change of the SCD classification in comparison with that recorded on the previous day was noted. Conclusions The SCD classification facilitates the reproducible and objective assessment of SCDs, enabling reliable monitoring over time and between individuals.

The Evaluation of Skin Turgor in Relation to Changes in Intracranial Pressure in Patients After Decompressive Hemicraniectomy

“…After a craniectomy, the pressure within the head can be gauged by palpating the skin flap and feeling whether the skin is tense. The skin is more compliant than the bone, so the brain can swell into tissue to a greater degree than the bone, and there are proposed classification systems to assess skin flaps after craniectomies [10]. Palpation of the skin, however, is subjective, which can lead to more variable results than using an instrument.…”