Flattening the curvature of synthetic materials to relieve scalp skin tension in cranioplasty

Mikami, Takeshi; Suzuki, Hime; Ukai, Ryo; Kimura, Yusuke; Miyata, Kei; Akiyama, Yukinori; Wanibuchi, Masahiko; Mikuni, Nobuhiro

doi:10.1016/j.jocn.2018.10.032

Cited by 3 publications

(10 citation statements)

References 22 publications

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“…After craniectomy, due to scalp shrinkage and volume contraction, it provided tension in cranioplasty. Previous literatures introduced various methods including flap reconstruction, 11 full-thickness skin grafting, 12 curvature flattening materials, 13 and scalp expansion. 14 In our experience, the use of skin-stretching device in cranioplasty could reduce scalp tension and easily suture for the appropriate patient.…”

Section: Discussionmentioning

confidence: 99%

Application of Skin-stretching Device for Closing Scalp Defect

Zhang

Xu²,

Liu³

et al. 2022

Journal of Craniofacial Surgery

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Background: The scalp defect was a clinical common constructive challenge. This research verified the efficacy of the skin-stretching device in the treatment of scalp defect and assessed the associated complications. Methods: The clinical data of 12 patients with scalp defect treated with skin-stretching device from January 2020 to January 2021 were collected. We used EASApprox skin-stretching device for the treatment of scalp defect. We described a detailed reconstruction procedure for this treatment. We collected the site, distance from wound edge and other characteristics of the wound, and recorded the number of stretching cycles, operation time, closed state, healing time, and observed postoperative complications and wound healing status. Results: In this research, the scalp defect was mainly caused by pressure ulcer, and mainly located in the parietooccipital site. The average distance from wound edge was 3.2 cm, the average stretching cycles was 4.2 times during the operation, and the average operation time was 43.5 minutes. Ten patients were directly sutured after stretching, and 2 patients underwent first-stage stretching to reduce the wound. The average time of wound healing was 13.5 days. Postoperative follow-up of 3 months, no patients had wound tear, necrosis, 1 patient suffered from wound exudation and infection due to poor nutrition. Skin function and final scar was acceptable. Conclusion: The treatment of skin-stretching device was effective for scalp defect and has the advantages of convenient operation, acceptable functional results, without severe complications. In addition to traditional treatment, this was a promising treatment. However, more clinical and preclinical research of the skin-stretching device were required.

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Section: Discussionmentioning

confidence: 99%

Application of Skin-stretching Device for Closing Scalp Defect

Zhang

Xu²,

Liu³

et al. 2022

Journal of Craniofacial Surgery

View full text Add to dashboard Cite

show abstract

“… 26 27 Although there is no consensus in the guidelines for the repair of these complex cranial reconstructions when in situ infection is encountered, curvature flatting has been shown to harbor has lower complication rate and is less invasive. 16 …”

Section: Discussionmentioning

confidence: 99%

“… 6 Although the posterior auricular artery bridging flap is vascularized by horizontal and vertical branches of the contralateral occipital artery, with their supply preoperatively confirmed by Doppler flowmetry, the incision for the bridging flap transected the occipital vessels thus increasing the risk of ischemia and subsequent infections. 19 20 21 For tension-free skin coverage, Mikami et al 16 reported on a total of 25 cranioplasty patients with minor flattening the curvature achieved skin release with acceptable cosmetic outcome. Unlike in the patient presented here, the major restraints of the extensive skin scarring, along with existing bridging flap forced us to consider an extensive flattening of the PEEK cranioplasty, in spite of obviously diminished cosmetic outcome.…”

Section: Discussionmentioning

confidence: 99%

“… 7 At the time of this writing, there are different methods available, 6 13 14 15 with slightly curvature flattening recently proposed to optimize scalp skin tension with consideration of the cosmetic outcome. 16 …”

mentioning

confidence: 99%

“…7 At the time of this writing, there are different methods available, 6,[13][14][15] with slightly curvature flattening recently proposed to optimize scalp skin tension with consideration of the cosmetic outcome. 16 Here, we describe a last resort treatment strategy for scalp release in a patient with substantial skin tension despite bridging flap and split-thickness skin graft. A custom-made alloplastic implant was extensively flattened in the curvature of the fronto-parietal area with consideration of the related brain hemisphere extension but less the cosmetic outcome.…”

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confidence: 99%

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Extensive Convexity Flattening of a Synthetic Skull Implant the Overcome Major Scalp Deficiency After Multiple Craniotomies

Andereggen

Marbacher

Dolp

et al. 2021

Journal of Craniofacial Surgery

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Multiple craniofacial surgeries and postoperative recalcitrant infections frequently can lead to secondary scalp tissue scarring and skin retraction. Although there are different methods of reducing and optimizing scalp skin tension, the authors describe a last resort treatment method of cranioplastic procedure, which despite of its unfavorable cosmetic outcome, relieves the skin tension through extensive flattening of the polyetheretherketone curvature. Thereby, a custom-made cranioplastic bone flap was extensively flattened in the curvature of the fronto-parietal area with consideration of the related brain hemisphere extension. The extent of bone curvature flatting reduced the skin tension significantly and allowed for plain and simple tension-free wound closure in a chronic smoker patient with poor skin quality and brain atrophy. Although brain extension was sufficient, the cosmetic outcome was unfavorable with regard to skull symmetry, but well accepted and satisfactory for the patient due to preoperative discussion outcome expectation from surgery. Thus, extensive polyetheretherketone curvature flattening is a straightforward and simple last resort treatment option for tension-free skin closure in high-risk patients with extensive skin scarring and retraction and previous reconstructive plastic skin relief procedures. However, this method is limited in patients with normal brain hemisphere extension.

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Additive Manufacturing and Reverse Engineering in Cranioplasty: A Personalized Approach to Minimize Skin Flap Complications

et al. 2021

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Cranioplasty is a procedure performed to repair defects in the human skull bone by surgically reconstructing the shape and function of the cranium. Several complications, both intraoperative and postoperative, can affect the procedure’s outcome (e.g., inaccuracies of the reconstructed shape, infections, ulcer, necrosis). Although the design of additive manufactured implants in a preoperative stage has improved the general quality of cranioplasties, potential complications remain significant, especially in the presence of critical skin tissue conditions. In this paper, an innovative procedure to improve the chances of a positive outcome when facing critical conditions in a cranioplasty is described. The proposed approach relies on a structured planning phase articulated in a series of digital analyses and physical simulations performed on personalized medical devices that guide the surgeon in defining surgical cuts and designing the implant. The ultimate goal is to improve the chances of a positive outcome and a fast recovery for the patient. The procedure, described in extenso in the paper, was positively tested on a cranioplasty case study, which presented high risk factors.

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Flattening the curvature of synthetic materials to relieve scalp skin tension in cranioplasty

Cited by 3 publications

References 22 publications

Application of Skin-stretching Device for Closing Scalp Defect

Application of Skin-stretching Device for Closing Scalp Defect

Extensive Convexity Flattening of a Synthetic Skull Implant the Overcome Major Scalp Deficiency After Multiple Craniotomies

Additive Manufacturing and Reverse Engineering in Cranioplasty: A Personalized Approach to Minimize Skin Flap Complications

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