title: Cranial reconstruction after a post-craniotomy empyema.
abstract: This article presents a case report of a cranioplasty performed after a post-craniotomy empyema with osteitis. The skull reconstruction was performed using a bioceramic implant and a combined muscular free flap of latissimus dorsi and serratus anterior. This procedure not only provided coverage of a wide skull defect but also allowed the filling of the intracranial dead space. Clinically, we observed an improvement of the patient's preoperative neurological status with a near-complete correction of her right hemiparaesis and phasic disorders. Eight months after the cranioplasty, (1) no recurrence of infection was noticed; (2) no distortion of the skull was noticeable and (3) the patient again experienced a normal social life. Using computed tomography (CT) scan images, we observed a re-expansion of the left cerebral hemisphere without any dead space or extradural collection. The only observable sequelae were a temporoparietal alopecia (10 cm x 4 cm) and a winging of the scapula, induced by the skin graft and the removal of the lower-third of the serratus anterior muscle, respectively. The use of a muscular free flap associated with a customised biomaterial allows a single-stage reconstruction of extensive skull defect (120 cm(2)) in a previously infected area.
authors.affiliation: Department of plastic and reconstructive surgery, Hôpital Nord, chemin des Bourrelly 13915 Marseille Cedex 20, France. jeff.chabas@neuf.fr
authors.forename: J-F
authors.initials: JF
authors.lastname: Chabas
authors.forename: C
authors.initials: C
authors.lastname: Dellavolpe
authors.forename: Y
authors.initials: Y
authors.lastname: Riah
authors.forename: T
authors.initials: T
authors.lastname: Bron
authors.forename: Y
authors.initials: Y
authors.lastname: Reynier
authors.forename: J-M
authors.initials: JM
authors.lastname: Kaya
authors.forename: D
authors.initials: D
authors.lastname: Casanova
mesh_terms: D000328:Adult; D018786:Bone Substitutes / Q000627:therapeutic use; D001927:Brain Diseases / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects*; D004653:Empyema / Q000601:surgery*; D005260:Female; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods; D012886:Skull / Q000601:surgery*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000601:surgery*
chemical_list: D018786:Bone Substitutes