Healing Exposed Calvarial Hardware Using Negative-Pressure Wound Therapy and Vashe Wound Solution: Case Report

Area of Science:

• Neurosurgery
• Plastic Surgery
• Wound Management

Background:

• Cranioplasty infections traditionally require hardware removal and delayed reconstruction.
• Syndrome of the trephined (SOT) necessitates cranioplasty, making hardware salvage critical.
• Existing treatment paradigms involve multiple surgeries and prolonged patient disfigurement.

Approach:

• A novel salvage strategy utilizing serial vacuum-assisted closure (VAC) with hypochlorous acid (HOCl) solution was employed.
• The treatment involved 11 days of VAC with HOCl, followed by 18 days of VAC alone.
• A split-thickness skin graft was placed over the granulation tissue for definitive closure.

Key Points:

• The patient's titanium cranioplasty hardware was successfully salvaged.
• The infection was resolved, and the syndrome of the trephined remained resolved at 7-month follow-up.
• Literature review supported conservative management for salvaging cranial reconstructions.

Conclusions:

• Serial VAC with HOCl solution offers an effective conservative strategy for managing cranioplasty infections.
• This approach obviates the need for explantation, repeat cranioplasty, and potential SOT recurrence.
• Further research with larger studies is warranted to confirm the efficacy of VAC with HOCl solution.