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Multiple Delayed Scalp Reconstruction for Complicated Cranial Defects.

Yoshiaki Sakamoto1, Eric Arnaud1

  • 1Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Minato, Japan; and Department of Pediatric Neurosurgery, Craniofacial Unit, Necker-Enfants Malades Hospital, Paris, France.

Plastic and Reconstructive Surgery. Global Open
|September 14, 2016
PubMed
Summary
This summary is machine-generated.

This study presents a multistaged technique for creating well-vascularized skin flaps for skull reconstruction after trauma. This method reduces infection and dehiscence risks, improving cosmetic outcomes in reconstructive plastic surgery.

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Area of Science:

  • Plastic Surgery
  • Neurosurgery
  • Biomedical Engineering

Background:

  • Emergency cranial decompression surgery often leaves scars near bony defects, complicating subsequent skull reconstruction.
  • Incisions on previous scars increase risks of dehiscence and infection during reconstructive plastic surgery.
  • A novel technique is needed to prepare well-vascularized tissue for skull reconstruction in challenging cases.

Purpose of the Study:

  • To describe and evaluate a multistaged technique for creating delayed, well-vascularized skin flaps for skull reconstruction.
  • To assess the safety and efficacy of this technique in patients with previous cranial trauma and surgery.
  • To improve cosmetic and functional outcomes in complex skull reconstruction.

Main Methods:

  • A 3-stage flap elevation technique with 4-week intervals was used to ensure adequate vascular delay.
  • Dissection beneath the galea aponeurotica was performed after initial flap elevation for enhanced vascularization.
  • Custom-made implants were utilized for the final skull reconstruction.
  • Patients were followed for 6 to 12 months post-surgery.

Main Results:

  • No complications such as infection, flap necrosis, or implant exposure were observed in four patients.
  • All patients reported high satisfaction with the cosmetic results of the skull reconstruction.
  • The technique successfully created well-vascularized delayed bipedicled skin flaps.

Conclusions:

  • The multistaged delayed skin flap technique is a viable and safe option for skull reconstruction when the initial scar is close to the bony defect.
  • Shifting scalp incisions away from the planned bony flap area is recommended to minimize infectious risks.
  • This approach offers a reliable solution for challenging reconstructive plastic surgery cases following cranial trauma.