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Advanced Cranial Reconstruction Utilizing Intracranial Free Flaps and Cranial Bone Grafts: An Algorithmic Approach Developed From the Modern Battlefield.
Anand R. Kumar, M.D. Diya Tantawi, MD Rocco Armonda, M.D. Ian Valerio MD, MS, MBA
Univ of Pittsburgh Medcial Center
2012-01-31
Presenter: Diya Tantawi, MD
Affidavit:
The resident (presenter), compiled the data, statistics and analysis. The resident contributed to warfare trauma services as he was active duty Army deployed in a forward position.
Director Name: Dr.Joseph Losee
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
Participants will be able to assess new staged algorithmic approaches in management of complex endocranial reconstruction after severe head trauma. participants will be able to address new techniques in complex cranial wound management.
How will your presentation be used by practicing physicians in the audience?
Participants application in the civilian world would be through the knowledge and application of advanced endocranial reconstruction for the severely injured trauma patient with significant head trauma in need of complex reconstruction after decompressive craniectomy.
Background: Warfare related craniectomy defects with large endocranial dead space are a unique reconstructive challenge. The objective of this study is to report outcomes after initiation of an algorithmic approach using intracranial free flaps, cranial bone autografts and dermal/fat grafts to treat complicated cranial frontal defects after war related decompressive craniectomy.
Methods: A review of injured personnel undergoing cranial defect reconstruction using alloplast, which included the orbital bar or associated with large endocranial dead space that subsequently required free flaps, bone grafts and dermal/fat grafts in the National Capital Area performed over a 52 month period.
Results: From March 2003 to July 2011, 13 patients were identified who underwent decompressive craniectomy and met inclusion criteria. Patient average age was 25. Average follow up was 870 days (2.4 years). 46% of all injuries were associated with an IED blast. Nine patients (69%) underwent hemi-craniectomies and four patients (31%) bi-frontal craniectomies. All 13 patients were complication free at the completion of the study period. Successful frontal bar/free flap reconstruction was present in 100% and successful secondary cranioplasty was present in 77% of the cohort. One patient underwent a contour improvement procedure.
Conclusions: Battlefield decompressive craniectomy for severe cranial injury has resulted in many unique challenges. Reconstruction of high-risk orbital bar defects and large endocranial dead space using an algorithmic approach resulted in high secondary cranioplasty retention rates. Decompressive craniectomy defects associated orbital, sinus, and skull base defects can be successfully reconstructed using an algorithmic approach with low morbidity and high success rates.
