Cranial-bone defects with depression deformity treated with ceramic implants and free-flap transfers

Cranial defects with depression deformities present unique challenges in reconstructive surgery. Hydroxyapatite ceramic is often used for its biocompatible properties. However, large defects may create an extradural dead space. This can lead to complications when closing the scalp under tension. Prior research has shown ceramic implants may not be sufficient in such cases. Surgeons must consider alternatives for optimal outcomes. Patients with repeated infections or prior irradiation face higher risks. No prior work had resolved the issue of dead space in severely depressed defects. This gap motivated the exploration of muscle flap integration with ceramic implants.

The aim of this study was to evaluate the use of muscle flaps with ceramic implants in cranial defects with depression deformities. Large defects often leave an extradural dead space. This can lead to complications if not addressed. The motivation was to find a reliable method for filling this space. Patients with repeated infections or irradiation are at higher risk. The study focused on three patients with severe deformities. Each required a combination of ceramic implants and muscle flaps. The goal was to avoid flap loss and ensure uneventful recovery.

Three patients with large cranial defects were treated using a combination of ceramic implants and muscle flaps. The first patient received a latissimus dorsi myocutaneous flap and a serratus anterior muscle flap. The second patient had a latissimus dorsi muscle flap and a small serratus anterior flap. The third patient used a latissimus dorsi myocutaneous flap to cover the implant. All flaps were placed under the ceramic implant to fill the extradural space. The surgical approach varied based on the patient's condition. Follow-up periods ranged from 12 to 35 months. No flap loss was recorded during the follow-up. The outcomes were evaluated for complications and success.

All three patients had uneventful clinical courses with no flap loss. The extradural space was effectively filled using muscle flaps. The first patient had a combination of latissimus dorsi and serratus anterior flaps. The second patient used a latissimus dorsi flap in an irradiated site. A small serratus anterior flap was used as a monitor in the second case. The third patient had a latissimus dorsi flap to cover the implant. Follow-up periods ranged from 12 to 35 months. The mean follow-up was 20.7 months. The use of muscle flaps reduced the risk of complications. The outcomes suggest muscle flaps are effective in severe depression deformities.

The study suggests that muscle flaps combined with ceramic implants can address cranial defects with depression deformities. The extradural space can be filled using muscle flaps. This approach reduces the risk of complications and flap loss. The authors propose that muscle flaps are effective in patients with severe deformities. The use of latissimus dorsi and serratus anterior flaps was successful. The follow-up periods showed no adverse outcomes. The method may be a viable option for patients with repeated infections or irradiation. The authors suggest this approach can be considered in similar cases.