Skin flap complications after decompressive craniectomy and cranioplasty: Proposal of classification and treatment options

Rienzo, Alessandro Dı; Pangrazi, Pier Paol; Riccio, Michele; Colasanti, Roberto; Ghetti, Ilaria; Iacoangeli, Maurizio

doi:10.4103/2152-7806.193724

Cited by 41 publications

(24 citation statements)

References 8 publications

(22 reference statements)

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“…Flap shape needs to be tailored to patient's anatomy considering scalp blood supply, especially in cases where vascularization may be already compromised. In general, it is definitely better to raise a larger flap [10]. Ensure good contouring of the implant.…”

Section: Discussionmentioning

confidence: 99%

Cranioplasty with polymethyl methacrylate implant: solutions of pitfalls

El-Ghani

2018

Egypt J Neurosurg

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Background: Cranioplasty is important to cover defects following skull surgery and trauma for restoration of function and cosmoses. The objective of the study is to describe the author's technical experience with the use of polymethyl methacrylate (PMMA) implant for cranioplasty to achieve the best results and avoid complications. Methods: The author describes the indications, locations and operative techniques of cranioplasty using polymethyl methacrylate (PMMA) implant for 75 patients. The implant was used to cover any small-or medium-sized (< 8 cm) cranial defect. Techniques have been done to facilitate reconstruction and to avoid complications to get excellent outcome. Results: This implant has been utilized in cases with excellent cosmetic results and no implant-related complications. Conclusions: Polymethyl methacrylate cranioplasty is a widely performed neurosurgical procedure with good cosmetic outcome and with little related implant complications when done in the proper time and proper techniques.

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Section: Discussionmentioning

confidence: 99%

Cranioplasty with polymethyl methacrylate implant: solutions of pitfalls

El-Ghani

2018

Egypt J Neurosurg

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“…Wound complications following DC or cranioplasty after DC have been classified as dehiscence, ulceration, or necrosis ( 27 ). The large size of the scalp flap and the increased probability of injury to the superficial temporal artery during emergency surgery predispose the wound edges to ischemia at the posterior parietal and temporal areas.…”

Section: Early Complicationsmentioning

confidence: 99%

Complications of Decompressive Craniectomy

et al. 2018

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Decompressive craniectomy (DC) has become the definitive surgical procedure to manage medically intractable rise in intracranial pressure due to stroke and traumatic brain injury. With incoming evidence from recent multi-centric randomized controlled trials to support its use, we could expect a significant rise in the number of patients who undergo this procedure. Although one would argue that the procedure reduces mortality only at the expense of increasing the proportion of the severely disabled, what is not contested is that patients face the risk of a large number of complications after the operation and that can further compromise the quality of life. Decompressive craniectomy (DC), which is designed to overcome the space constraints of the Monro Kellie doctrine, perturbs the cerebral blood, and CSF flow dynamics. Resultant complications occur days to months after the surgical procedure in a time pattern that can be anticipated with advantage in managing them. New or expanding hematomas that occur within the first few days can be life-threatening and we recommend CT scans at 24 and 48 h postoperatively to detect them. Surgeons should also be mindful of the myriad manifestations of peculiar complications like the syndrome of the trephined and neurological deterioration due to paradoxical herniation which may occur many months after the decompression. A sufficiently large frontotemporoparietal craniectomy, 15 cm in diameter, increases the effectiveness of the procedure and reduces chances of external cerebral herniation. An early cranioplasty, as soon as the brain is lax, appears to be a reasonable choice to mitigate many of the late complications. Complications, their causes, consequences, and measures to manage them are described in this chapter.

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“…The 3D-solid customized PMMA prosthesis [24] eliminated the disadvantage of liquid PMMA, such as the exothermic reaction during polymerization, the surgeon dependency of the intra-operative preparation, the relative contraindication in pregnancy, and the fact that toxic fumes are released.…”

Section: Polymethylmethacrylatementioning

confidence: 99%

“…As a consequence, several issues remain open to debate, including indications, optimal surgical technique, optimal material, timing of CP, CP with concomitant hydrocephalus (HC), and CP in paediatric patients [13,18,23,37,47,69,75,93,94].…”

Section: Introductionmentioning

confidence: 99%

Consensus statement from the international consensus meeting on post-traumatic cranioplasty

et al. 2020

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Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.

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Skin flap complications after decompressive craniectomy and cranioplasty: Proposal of classification and treatment options

Cited by 41 publications

References 8 publications

Cranioplasty with polymethyl methacrylate implant: solutions of pitfalls

Cranioplasty with polymethyl methacrylate implant: solutions of pitfalls

Complications of Decompressive Craniectomy

Consensus statement from the international consensus meeting on post-traumatic cranioplasty

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