Two-Staged Cranial Reconstruction: Tissue Expansion, Galeocapsular Flaps, and CAD/CAM Three-Dimensional Titanium...

Area of Science:

• Neurosurgery
• Plastic Surgery
• Biomedical Engineering

Background:

• Cranial defect reconstruction after surgery is challenging, especially with bone loss and limited soft tissue.
• Patient-specific implants (PSIs) offer alternatives to traditional methods like revision osteotomy or repeat cranioplasty.

Purpose of the Study:

• To describe a novel two-stage reconstructive technique for late cranial contour restoration.
• To evaluate the safety and efficacy of this approach in a patient with residual deformity after previous surgery.

Main Methods:

• A 19-year-old male with frontal and parietal bone defects underwent a two-stage procedure.
• Stage 1 involved gradual expansion of a parietal tissue expander.
• Stage 2 utilized a PSI designed with virtual planning and a galeal flap for soft-tissue coverage.

Main Results:

• The technique successfully corrected frontal and parietal depression and supraorbital retrusion.
• Vascularized soft-tissue coverage was achieved using a galeocapsular flap and expanded scalp.
• Satisfactory cranial contour and projection were maintained at 12-month follow-up with no complications.

Conclusions:

• This two-stage technique combining tissue expansion and patient-specific implants is a safe and effective option.
• It is suitable for selected patients requiring late cranial reconstruction after prior surgeries.