title: Use of the vacuum-assisted closure device in enhancing closure of a massive skull defect.
abstract: OBJECTIVE
  The objective was to describe a novel technique for reconstructing the cranial vertex without the use of free tissue transfer.
  
  
  METHODS
  Case report, literature review, and discussion.
  
  
  METHODS
  A 50-year-old woman presented from a remote Pacific Island community with a 12 x 14-cm, necrotic, grossly contaminated eccrine gland carcinoma of the cranial vertex that extended through the calvarium but did not invade the dura. Following tumor extirpation, the resulting bony defect was 10 x 12 cm in size, with a concomitant scalp defect of 14 x 16 cm. Free tissue transfer was impossible because of severe intimal peripheral vascular disease, posing a challenging reconstructive dilemma. After tumor resection, the bony edges were covered with local scalp flaps and the vacuum-assisted closure device was placed over the wound at a constant setting of -50 mm Hg. The vacuum-assisted closure device was changed three times per week for 3 weeks.
  
  
  RESULTS
  A thick, 1-cm bed of granulation tissue developed over the dura, allowing temporary coverage by a split-thickness skin graft, and the scalp defect decreased in size by approximately 25%. The patient did not develop meningitis, headache, or localized infection as a result of placement of the vacuum-assisted closure device and tolerated the vacuum-assisted closure well. After a requisite period of healing, tissue expanders and calvarial reconstruction will be performed.
  
  
  CONCLUSIONS
  Use of the vacuum-assisted closure device is a safe, reliable adjunct in the closure of large cranial defects with exposed dura and offers a novel reconstructive option for complex defects of the head and neck.
authors.affiliation: Department of Otolaryngology, Tripler Army Medical Center, Honolulu, Hawaii, USA.
authors.forename: Umesh S
authors.initials: US
authors.lastname: Marathe
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Sniezek
mesh_terms: D004439:Eccrine Glands / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D012535:Scalp / Q000601:surgery*; D016038:Skin Transplantation; D012888:Skull Neoplasms / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D013544:Sweat Gland Neoplasms / Q000601:surgery*; D014618:Vacuum; D014945:Wound Healing