Original Article

Salvage of postcranioplasty implant exposure using free tissue transfer

Pang-Yun Chou MD

orcid.org/0000-0002-8390-7059

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan

Search for more papers by this author

Cheng-Hung Lin MD,

Cheng-Hung Lin MD

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan

Search for more papers by this author

Chung-Chen Hsu MD,

Chung-Chen Hsu MD

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan

Search for more papers by this author

Wei-Hsun Yang MD,

Wei-Hsun Yang MD

Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

Search for more papers by this author

Alex A. Kane MD,

Alex A. Kane MD

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Fort Worth, Texas

Search for more papers by this author

Chih-Hung Lin MD,

Corresponding Author

Chih-Hung Lin MD

[email protected]

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

Correspondence Chih-Hung Lin, Department of Plastic and Reconstructive Surgery, ChiaYi Chang Gung Memorial Hospital, 6 West Sec. Chiapu Road, Putzu City, Chiayi Hsien, Taiwan, Republic of China. Email: [email protected]Search for more papers by this author

Pang-Yun Chou MD,

Pang-Yun Chou MD

orcid.org/0000-0002-8390-7059

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan

Search for more papers by this author

Cheng-Hung Lin MD,

Cheng-Hung Lin MD

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan

Search for more papers by this author

Chung-Chen Hsu MD,

Chung-Chen Hsu MD

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan

Search for more papers by this author

Wei-Hsun Yang MD,

Wei-Hsun Yang MD

Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

Search for more papers by this author

Alex A. Kane MD,

Alex A. Kane MD

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Fort Worth, Texas

Search for more papers by this author

Chih-Hung Lin MD,

Corresponding Author

Chih-Hung Lin MD

[email protected]

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

First published: 17 May 2017

https://doi.org/10.1002/hed.24813

Citations: 22

Share a link

Email
Wechat
Bluesky

Abstract

Background

Refractory implant exposure is frustrating after cranioplasty. The purpose of this study was for the authors to present their experience with free tissue transfer for salvage of postcranioplasty implant exposure.

Methods

A retrospective medical chart review was conducted on all free tissue transfers performed for exposed implant coverage after cranioplasty between January 2004 and February 2016.

Results

Twelve free flaps were performed in 11 patients who underwent postcranioplasty with implant exposure, and whose attempted implant coverage using locoregional flaps had failed. The free flaps used included anterolateral thigh flap, radial forearm flap, anteromedial thigh and rectus femoris chimeric flap, latissimus dorsi flap, gracilis flap, and Juri flap. The flap survival rate was 100%, and 10 of 11 implants (91%) were salvaged without removal.

Conclusions

Free tissue transfer should be considered as the preferred reconstructive option for postcranioplasty exposed implant salvage. High rate of implant salvage (>90%) is possible even with chronic implant exposure (>3 months).

REFERENCES

1 Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst Rev. 2006;(1): CD003983.
PubMed Web of Science® Google Scholar
2 Wachter D, Reineke K, Behm T, Rohde V. Cranioplasty after decompressive hemicraniectomy: underestimated surgery-associated complications? Clin Neurol Neurosurg. 2013; 115(8): 1293–1297.
10.1016/j.clineuro.2012.12.002
PubMed Web of Science® Google Scholar
3 Stephens FL, Mossop CM, Bell RS, et al. Cranioplasty complications following wartime decompressive craniectomy. Neurosurg Focus. 2010; 28(5): E3.
10.3171/2010.2.FOCUS1026
PubMed Web of Science® Google Scholar
4 Gooch MR, Gin GE, Kenning TJ, German JW. Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus. 2009; 26(6): E9.
10.3171/2009.3.FOCUS0962
PubMed Web of Science® Google Scholar
5 Reddy S, Khalifian S, Flores JM, et al. Clinical outcomes in cranioplasty: risk factors and choice of reconstructive material. Plast Reconstr Surg. 2014; 133(4): 864–873.
10.1097/PRS.0000000000000013
CAS PubMed Web of Science® Google Scholar
6 Wiggins A, Austerberry R, Morrison D, Ho KM, Honeybul S. Cranioplasty with custom-made titanium plates---14 years experience. Neurosurgery. 2013; 72(2): 248–256; discussion 256.
10.1227/NEU.0b013e31827b98f3
PubMed Web of Science® Google Scholar
7 Aydin S, Kucukyuruk B, Abuzayed B, Aydin S, Sanus GZ. Cranioplasty: review of materials and techniques. J Neurosci Rural Pract. 2011; 2(2): 162–167.
10.4103/0976-3147.83584
PubMed Google Scholar
8 Hayward RD. Cranioplasty: don't forget the patient's own bone is cheaper than titanium. Br J Neurosurg. 1999; 13(5): 490–491.
10.1080/02688699908540624
CAS PubMed Web of Science® Google Scholar
9 Afifi AM, Gordon CR, Pryor LS, Sweeney W, Papay FA, Zins JE. Calcium phosphate cements in skull reconstruction: a meta-analysis. Plast Reconstr Surg. 2010; 126(4): 1300–1309.
10.1097/PRS.0b013e3181ead057
CAS PubMed Web of Science® Google Scholar
10 Janecka IP. New reconstructive technologies in skull base surgery: role of titanium mesh and porous polyethylene. Arch Otolaryngol Head Neck Surg. 2000; 126(3): 396–401.
10.1001/archotol.126.3.396
CAS PubMed Web of Science® Google Scholar
11 Thien A, King NK, Ang BT, Wang E, Ng I. Comparison of polyetheretherketone and titanium cranioplasty after decompressive craniectomy. World Neurosurg. 2015; 83(2): 176–180.
10.1016/j.wneu.2014.06.003
PubMed Web of Science® Google Scholar
12 Mukherjee S, Thakur B, Haq I, Hettige S, Martin AJ. Complications of titanium cranioplasty---a retrospective analysis of 174 patients. Acta Neurochir (Wein). 2014; 156(5): 989–998; discussion 998.
10.1007/s00701-014-2024-x
PubMed Web of Science® Google Scholar
13 De Bonis P, Frassanito P, Mangiola A, Nucci CG, Anile C, Pompucci A. Cranial repair: how complicated is filling a “hole”? J Neurotrauma. 2012; 29(6): 1071–1076.
10.1089/neu.2011.2116
PubMed Web of Science® Google Scholar
14 Klinger DR, Madden C, Beshay J, White J, Gambrell K, Rickert K. Autologous and acrylic cranioplasty: a review of 10 years and 258 cases. World Neurosurg. 2014; 82(3–4): e525–e530.
10.1016/j.wneu.2013.08.005
PubMed Web of Science® Google Scholar
15 Takumi I, Akimoto M. One-stage reconstruction using a vascularized calvarial flap for intractable scalp ulcers in relation with cranial implants without removing the whole prosthesis. Neurosurg Rev. 2009; 32(3): 363–368; discussion 368.
10.1007/s10143-009-0196-2
PubMed Web of Science® Google Scholar
16 Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plast Reconstr Surg. 2005; 116(4): 54e-72e.
10.1097/01.prs.0000179188.25019.6c
CAS PubMed Web of Science® Google Scholar
17 Yoon SH, Burm JS, Yang WY, Kang SY. Vascularized bipedicled pericranial flaps for reconstruction of chronic scalp ulcer occurring after cranioplasty. Arch Plast Surg. 2013; 40(4): 341–347.
10.5999/aps.2013.40.4.341
PubMed Google Scholar
18 Beasley NJ, Gilbert RW, Gullane PJ, Brown DH, Irish JC, Neligan PC. Scalp and forehead reconstruction using free revascularized tissue transfer. Arch Facial Plast Surg. 2004; 6(1): 16–20.
10.1001/archfaci.6.1.16
PubMed Google Scholar
19 Muresan C, Hui-Chou HG, Dorafshar AH, Manson PN, Rodriguez ED. Forehead reconstruction with microvascular flaps: utility of aesthetic subunits. J Reconstr Microsurg. 2012; 28(5): 319–326.
10.1055/s-0032-1311690
PubMed Web of Science® Google Scholar
20 van Driel AA, Mureau MA, Goldstein DP, et al. Aesthetic and oncologic outcome after microsurgical reconstruction of complex scalp and forehead defects after malignant tumor resection: an algorithm for treatment. Plast Reconstr Surg. 2010; 126(2): 460–470.
10.1097/PRS.0b013e3181de2260
CAS PubMed Web of Science® Google Scholar
21 McCombe D, Donato R, Hofer SO, Morrison W. Free flaps in the treatment of locally advanced malignancy of the scalp and forehead. Ann Plast Surg. 2002; 48(6): 600–606.
10.1097/00000637-200206000-00006
CAS PubMed Web of Science® Google Scholar
22 Sweeny L, Eby B, Magnuson JS, Carroll WR, Rosenthal EL. Reconstruction of scalp defects with the radial forearm free flap. Head Neck Oncol. 2012; 4: 21.
10.1186/1758-3284-4-21
PubMed Web of Science® Google Scholar
23 St-Hilaire H, Mithani SK, Taylor J, Simmons OP, Singh N, Rodriguez ED. Restoring the failed cranioplasty: nonanatomical titanium mesh with perforator flap. Plast Reconstr Surg. 2009; 123(6): 1813–1817.
10.1097/PRS.0b013e3181a65bce
CAS PubMed Web of Science® Google Scholar
24 Labow BI, Rosen H, Pap SA, Upton J. Microsurgical reconstruction: a more conservative method of managing large scalp defects? J Reconstr Microsurg. 2009; 25(8): 465–474.
10.1055/s-0029-1224860
PubMed Web of Science® Google Scholar
25 Viol A, Pradka SP, Baumeister SP, et al. Soft-tissue defects and exposed hardware: a review of indications for soft-tissue reconstruction and hardware preservation. Plast Reconstr Surg. 2009; 123(4): 1256–1263.
10.1097/PRS.0b013e31819f2b5e
CAS PubMed Web of Science® Google Scholar
26 Yadla S, Campbell PG, Chitale R, Maltenfort MG, Jabbour P, Sharan AD. Effect of early surgery, material, and method of flap preservation on cranioplasty infections: a systematic review. Neurosurgery. 2011; 68(4): 1124–1129; discussion 1130.
10.1227/NEU.0b013e31820a5470
PubMed Web of Science® Google Scholar
27 Lopez J, Zhong SS, Sankey EW, et al. Time interval reduction for delayed implant-based cranioplasty reconstruction in the setting of previous bone flap osteomyelitis. Plast Reconstr Surg. 2016; 137(2): 394e-404e.
10.1097/01.prs.0000475770.14396.1e
CAS PubMed Web of Science® Google Scholar

Citing Literature

Volume39, Issue8

August 2017

Pages 1655-1661

Salvage of postcranioplasty implant exposure using free tissue transfer

Abstract

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Salvage of postcranioplasty implant exposure using free tissue transfer

Abstract

Background

Methods

Results

Conclusions

REFERENCES

Citing Literature

References

Related

Information