Use of an Acellular Dermal Matrix Graft to Address a Contour Deformity in the Temporal Fossa: A Novel Application

Abstract

Cranioplasty of the frontotemporoparietal region is particularly challenging given the thin skin and musculature in this area, predisposing one to an increased risk of contour deformity and cosmetic dissatisfaction following surgery. Herein, we describe a 36-year-old male who initially presented with a gunshot wound (GSW) to the head and a right parietal skull fracture and underwent a revision of his cranioplasty procedure due to significant temporalis muscle atrophy, resulting in a sunken appearance of the right temporalis fossa following a craniectomy and multiple surgeries for hematoma evacuation. The patient underwent cranioplasty for definitive repair of his defect, and at follow-up, significant temporalis muscle atrophy resulted in a sunken appearance of the right temporalis fossa. A calcium phosphate bone substitute was used to fill the deformity, but dissolution and migration of the cement at follow-up necessitated a repeat cranioplasty procedure. Alloderm™ (Allergan Corp., Dublin, Ireland), an acellular dermal matrix derived from cadaveric skin, which has been previously used for dural repair, was successfully used in this study as a buffer between the skin and a cranioplasty implant to enhance cosmetic outcomes in a revision cranioplasty procedure following temporalis muscle atrophy.

Expanding Our Role in Headache Management

“…As previously mentioned, ADM has been used to address contour-related deformities secondary to craniotomies and may help separate the sensitive skin from the underlying bony edges or hardware. 60,61 Although there has yet to be a study evaluating its effectiveness in pain reduction for craniotomies, ADM has been described for pain improvement in chronic neuropathic pain of the extremities. 62 Future studies that evaluate the benefits of ADM on pain improvement in patients with PCH are needed.…”