Latissimus Dorsi-Myocutaneous Flap in the Repair of Titanium Mesh Exposure and Scalp Defect After Cranioplasty

Dong, Liwei; Dong, Yaping; Liu, Chaohua; Geng, Jiao; Liu, Hengxin; Pei, Jiaomiao; Hao, Daifeng; Ma, Xianjie; Xia, Wensen

doi:10.1097/scs.0000000000006016

Cited by 13 publications

(12 citation statements)

References 16 publications

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“…Robust soft tissue coverage is necessary to re‐establish the barrier that shields the brain from external pathogens, and secondarily restore an aesthetic appearance. The use of vascularized muscle free flaps to treat large scalp and cranial defects has been well‐described in recent studies (Dong et al, 2020; Lin et al, 2014; Ray et al, 2020). A muscle flap has the advantage of an abundant vasculature, and thus can resist infection, and has the potential to thicken the atrophied scalp and fill in the dead space.…”

Section: Discussionmentioning

confidence: 99%

The use of free myocutaneous flap and implant reinsertion for staged cranial reconstruction in patients with titanium mesh exposure and large skull defects with soft tissue infection after cranioplasty: Report of 19 cases

Han

Chen

et al. 2021

Microsurgery

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Background Management of cranial defects following failed cranioplasty due to titanium mesh exposure and infection is challenging. The purpose of this report is to describe a modified technique using a free myocutaneous flap transfer for primary soft tissue reconstruction, and titanium mesh reinsertion for cranioplasty revision. Methods Nineteen patients with titanium mesh exposure and infection following cranioplasty were treated from January 2012 to January 2019. The average patient age was 41.89 years and the average size of the cranial defect was 7.74 × 13.92 cm. The reasons for craniotomy were craniocerebral trauma (n = 17), cerebrovascular disease (n = 1), and brain tumor (n = 1). The mean duration between implant exposure and current procedure was 7.16 months. Implant was removed and a free myocutaneous flap was designed to cover both scalp and cranium defects. After a mean duration of 12.32 months, implants were re‐inserted in a vascularized pocket at the second stage by elevating a plane between the previously transferred fascia layer and muscle layer. Results The average sizes of the muscle flaps and skin paddles were 7.74 × 13.92 cm and 4.97 × 8.97 cm. The average size of the implants was 8.24 × 14.42 cm. All flaps survived completely with no complication. After an average follow‐up of 48.16 months there were no cranioplasty failures. Functional coverage of craniectomy defect sites with normalized head contour was achieved. Conclusions The use of free myocutaneous flap and implant reinsertion achieved durable cranial and scalp defect reconstruction and aesthetic outcomes. The myocutaneous flap increases blood supply to the scalp, which may reduce the chances of infection and implant re‐exposure.

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Section: Discussionmentioning

confidence: 99%

The use of free myocutaneous flap and implant reinsertion for staged cranial reconstruction in patients with titanium mesh exposure and large skull defects with soft tissue infection after cranioplasty: Report of 19 cases

Han

Chen

et al. 2021

Microsurgery

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“…Standard management of skin defects with titanium mesh exposure involves wound debridement, and removal or exchange of implants to prevent secondary infection and to achieve suitable aesthetic outcomes [6,11]. Appropriate coverage with skin flaps, such as forehead muscle flaps, temporal island flaps and LD free flaps should be performed afterwards [2,12]. However, few studies have described cases of recurrent skin defects from not completely removing the titanium mesh.…”

Section: Discussionmentioning

confidence: 99%

Repetitive Exposure of Titanium Mesh after Cranioplasty: A Case Report

2022

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Cranial defects are often managed with cranioplasty, where synthetic substances are still extensively used despite the advantages of using biological materials. Among the complications of cranioplasty, skin defects with implant exposure are the most common, with a particularly high incidence when titanium mesh is used. This is a case report of a 32-year-old patient who underwent cranioplasty with titanium mesh. After 2 years, a forehead skin defect with mesh exposure occurred, onto which a latissimus dorsi free flap was applied without removing the mesh. Ten months later, the patient was consulted for another skin defect, and a second latissimus dorsi free flap was applied with near-total mesh removal. After 6 months, another cranioplasty with hydroxyapatite bone cement and flap modification was performed. Lastly, revision surgery with complete removal of the mesh remaining in the right eyebrow was executed after 1 year, and no major complications were seen during the 4 months of follow-up. Through this experience, we suggest that skin defects with mesh exposure need to be managed with total removal of the metal material, followed by cranioplasty using another material and appropriate soft tissue coverage over the reconstructed cranium.

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“…(1) The LD flap has a large harvesting area, and there is no need to locate the perforators. (2) Some authors have reported that if the wound is covered at an early stage, the risk of infection is lower (Dong et al, 2020; Ju et al, 2018). In our case series, no wound infection or osteomyelitis was recorded in any patient during the follow‐up period.…”

Section: Discussionmentioning

confidence: 99%

Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow‐through anterolateral thigh perforator flap transfer

Qing

et al. 2021

Microsurgery

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Background: Management of large wounds of the lower extremities remains a challenge for plastic and reconstructive surgeons. Herein, a surgical technique and clinical algorithm using the combined transfer of a latissimus dorsi (LD) musculocutaneous flap and flow-through anterolateral thigh (ALT) perforator flap for the treatment of extensive soft-tissue defects is described. Methods: From January 2012 to September 2018, 12 patients (six men and six women) aged 6-37 years, sustained injuries in road traffic accidents with large softtissue defects in the lower extremities. Seven cases were Gustillo Anderson type IIIB open fractures and two cases were Gustillo Anderson type IIIC open fractures. Two wounds were located in the knee joint, four in the calf, and six in the ankle and foot. The skin defect size ranged from 25 Â 20 cm 2 to 36 Â 25 cm 2 . All patients in this series underwent reconstruction using combined transfer of the LD musculocutaneous flap and flow-through ALT perforator flap, wherein the LD was attached through its pedicle to the distal continuation of the ALT flap.Results: The size of the flow-through ALT perforator flaps ranged from 13.5 Â 6.5 cm 2 to 31 Â 8.5 cm 2 . The size of the LD musculocutaneous skin paddle ranged from 25 Â 6 cm 2 to 34 Â 7 cm 2 , and that of the muscle paddle ranged from 13 Â 3.5 cm 2 to 30 Â 11 cm 2 . One patient experienced postoperative thrombosis of the venous pedicle, and the flap was salvaged after emergency re-exploration and thrombectomy.No other complications were observed postoperatively. The mean follow-up period was 26.8 months. All patients were able to ambulate independently at the end of the follow-up period. Conclusions:The combined transfer of the LD musculocutaneous flap and flowthrough ALT perforator flap ensured adequate surface coverage, making it a feasible procedure for large soft-tissue defects. | INTRODUCTIONHigh-energy traumatic injury often causes significant soft-tissue loss.Early reconstruction of extensive soft-tissue defects is essential to salvage an extremity and restore its functionality (Soni et al., 2012;Zeltzer & Van Landuyt, 2012;Zhu et al., 2013). Fabricated chimeric flaps or sequential chimeric flaps based on the flow-through anterolateral thigh (ALT) perforator flap were commonly used to restore complex lower extremity defects. However, several reports have focused on the simultaneous transfer of microsurgically

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Latissimus Dorsi-Myocutaneous Flap in the Repair of Titanium Mesh Exposure and Scalp Defect After Cranioplasty

Cited by 13 publications

References 16 publications

The use of free myocutaneous flap and implant reinsertion for staged cranial reconstruction in patients with titanium mesh exposure and large skull defects with soft tissue infection after cranioplasty: Report of 19 cases

The use of free myocutaneous flap and implant reinsertion for staged cranial reconstruction in patients with titanium mesh exposure and large skull defects with soft tissue infection after cranioplasty: Report of 19 cases

Repetitive Exposure of Titanium Mesh after Cranioplasty: A Case Report

Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow‐through anterolateral thigh perforator flap transfer

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