Sinking Skin Flap Syndrome following Posttraumatic Hydrocephalus.

Area of Science:

• Neurosurgery
• Critical Care Medicine
• Trauma Surgery

Background:

• Sinking Skin Flap Syndrome (SSFS) is a rare complication following decompressive craniectomy (DC).
• Literature on SSFS primarily consists of case reports, lacking comprehensive management strategies.
• This study presents a case series focusing on SSFS in patients with hydrocephalus requiring ventriculoperitoneal (VP) shunting prior to cranioplasty.

Observation:

• Three patients who underwent DC for trauma developed SSFS after VP shunting.
• Patients presented with neurological deficits, including hemiparesis and stupor.
• The intervention involved VP shunt occlusion, rehydration, and early cranioplasty with a flattened Polymethyl Methacrylate (PMMA) bone flap.

Findings:

• All three patients showed gradual postoperative recovery after the described management.
• The treatment successfully reversed neurological deficits and avoided further complications.
• Key therapeutic factors identified include Trendelenburg positioning, adequate rehydration, and specific cranioplasty techniques.

Implications:

• The findings suggest a multimodal approach to managing SSFS in shunted patients.
• Early intervention and specific surgical techniques can mitigate SSFS-related complications.
• This study contributes to a better understanding and management of SSFS, potentially improving patient outcomes after DC.