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The use of AllodermTM in salvage of threatened autologous and alloplastic cranioplasty
Kyle J. Chepla MD
Donald J. Harvey MD
Ali S. Totonchi MD
University Hospitals - Case Medical Center. Cleveland, OH
2013-03-14
Presenter: Donald J. Harvey MD
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. Please make a statement as to how much of the above work represents the original work of the resident.
Director Name: Hooman T. Soltanian
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Decompressive craniectomy is a potentially life-saving procedure that reduces intracranial pressure. Wound healing complications after calvarial reconstruction are common as the standard temporal reverse question-mark incision for craniectomy may damage the superficial temporal artery and creates a narrow pedicle to flap ratio. Explantation and further surgical procedures are required in up to 10% of patients due to exposure and infection of the bone flap or alloplastic reconstruction.
Methods: Since 2011, four patients who underwent previous cranioplasty were treated by the senior author for scalp flap thinning with threatened implant exposure. In all patients the defect created by debridement of the skin margins was repaired with rotational scalp flaps supplemented by placement of AllodermTM under the incision to thicken the skin flaps, protect them from pressure from the underlying reconstruction, and prevent implant exposure in the event of wound dehiscence. Skin grafting was used to backfill the rotational flap defect in three patients.
Results: On average 39 cm2 of skin was debrided and the size of scalp flap ranged from 260-750 cm2. At an average follow-up of 272 days (116-585 days) all four patients went on to heal without complications, including implant infection or wound dehiscence.
Conclusions: Exposure of calvarial reconstruction leads to further surgical procedures that require repeated skin flap elevation that can result in thinning of the flaps and predisposes them for further wound healing complications. This study demonstrates that AllodermTM, in conjunction with rotational scalp flaps, is successful for salvage of cranioplasty threatened by thinning skin flaps.
