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Staged reconstruction of a chronically infected large skull defect using free tissue transfer and a patient-specific polyetheretherketone implant

Archives of Craniofacial Surgery 2020년 21권 5호 p.309 ~ 314
문승진, 전홍배, 김의현, 유대현, 김용욱, 홍종원,
소속 상세정보
문승진 ( Moon Seung-Jin ) - Yonsei University College of Medicine Department of Plastic and Reconstructive Surgery
전홍배 ( Jeon Hong-Bae ) - Yonsei University College of Medicine Department of Plastic and Reconstructive Surgery
김의현 ( Kim Eui-Hyun ) - Yonsei University College of Medicine Department of Neurosurgery
유대현 ( Lew Dae-Hyun ) - Yonsei University College of Medicine Department of Plastic and Reconstructive Surgery
김용욱 ( Kim Yong-Oock ) - Yonsei University College of Medicine Department of Plastic and Reconstructive Surgery
홍종원 ( Hong Jong-Won ) - Yonsei University College of Medicine Department of Plastic and Reconstructive Surgery

Abstract


Reconstructions of extensive composite scalp and cranial defects are challenging due to high incidence of postoperative infection and reconstruction failure. In such cases, cranial reconstruction and vascularized soft tissue coverage are required. However, optimal reconstruction timing and material for cranioplasty are not yet determined. Herein, we present a large skull defect with a chronically infected wound that was not improved by repeated debridement and antibiotic treatment for 3 months. It was successfully treated with anterolateral thigh (ALT) free flap transfer for wound salvage and delayed cranioplasty with a patient-specific polyetheretherketone implant. To reduce infection risk, we performed the cranioplasty 1 year after the infection had resolved. In the meantime, depression of ALT flap at the skull defect site was observed, and the midline shift to the contralateral side was reported in a brain computed tomography (CT) scan, but no evidence of neurologic deterioration was found. After the surgery, sufficient cerebral expansion without noticeable dead-space was confirmed in a follow-up CT scan, and there was no complication over the 1-year follow-up period.

키워드

Cranioplasty; Free tissue flap; Polyetheretherketone

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