Postoperative infection after duraplasty with expanded polytetrafluoroethylene sheet

Dural reconstruction is a significant problem in many cases of decompressive craniotomy and dural defect. Expanded polytetrafluoroethylene (ePTFE) sheet have been used as a dura mater substitute for duraplasty. The outcomes of 83 consecutive patients at our institution were reviewed who underwent external decompression and closure with the ePTFE sheet between August 1995 and December 2000. Eight cases of infection occurred. Seven patients had infection with subdural empyema after cranioplasty with autologous bone. Three patients improved after removal of only the infected bone. One patient improved after removal of the infected bone and ePTFE sheet. One patient experienced wound infection after the original operation. Four patients subsequently developed local and severe inflammation with skin erythema until the ePTFE sheet was removed. Four patients had severe recurrent infections which required subsequent therapy such as vascularized free rectus abdominis muscle flap transfer. Duraplasty with ePTFE sheet might promote infection and poor circulation in the skin flap. The ePTFE sheet should be removed at an early stage in a patient with infection.