title: Primary reconstruction of open depressed skull fractures with titanium mesh.
abstract: Open skull fractures have been traditionally managed in 2 stages: urgent craniotomy and elevation of the fracture with removal of contaminated bone, debridement, and delayed cranioplasty. Primary, single-stage repair of these injures has been said to entail risks such as infections. Recent experience, however, disproved these concerns. We used a primary single-stage reconstruction for patients presenting with open depressed skull fractures. All patients received antibiotic prophylaxis. The patients underwent elevation of the compound fracture and craniotomy if necessary. Debridement was performed, followed by skull reconstruction using a 0.6-mm titanium mesh. We present 5 consecutive male patients (age, 32.2 +/- 15.6 years) who underwent primary reconstruction of open depressed skull fractures. Clinical and radiologic follow-up was performed 2 months after surgery. The duration of the surgery was 2 +/- 1.6 hours. The size of the implanted mesh was 13 +/- 13.1 cm. No infection was detected in our series, with a follow-up period of 22 +/- 6.5 months (range, 16-29 months). The cosmetic result was defined in 4 patients as "excellent" and in 1 patient as "good."Primary reconstruction of open skull fractures with titanium mesh is feasible, safe, and cosmetically preferable than the conventional staged approach. The introduction into clinical practice can be warranted.
authors: Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.
authors: Serge
authors: S
authors: Marbacher
authors: Robert H
authors: RH
authors: Andres
authors: Ali-Reza
authors: AR
authors: Fathi
authors: Javier
authors: J
authors: Fandino
mesh_terms: D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D001672:Biocompatible Materials; D001843:Bone Cements / Q000627:therapeutic use; D001863:Bone Screws; D003399:Craniotomy / Q000379:methods; D003646:Debridement; D017886:Durapatite / Q000627:therapeutic use; D004954:Esthetics; D005240:Feasibility Studies; D005500:Follow-Up Studies; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012449:Safety; D020204:Skull Fracture, Depressed / Q000601:surgery*; D013526:Surgical Mesh; D013997:Time Factors; D014025:Titanium
chemical_list: D001672:Biocompatible Materials; D001843:Bone Cements; D017886:Durapatite; D014025:Titanium