title: New reconstructive technologies after decompressive craniectomy in traumatic brain injury: the role of three-dimensional titanium mesh.
abstract: Functional and aesthetic reconstruction after wide decompressive craniectomy directly correlates with subsequent quality of life. Advancements in the development of biomaterials have now made three-dimensional (3-D) titanium mesh a new option for the repair of skull defects after craniectomy. The purpose of this study was to review aesthetic and surgical outcomes and complications of patients who had skull defects repaired with 3-D titanium mesh. The records of 40 adult patients (31 unilateral craniectomies and 9 bilateral craniectomies) who underwent a computer-assisted designed titanium mesh implant at a university hospital from January 2008 to January 2010 were retrospectively reviewed. Aesthetic outcomes, cranial nerve V and VII function, and complications (hardware extrusions, meningitis, osteomyelitis, brain abscess, and pneumocephalus) were evaluated. The craniofacial symmetry, implant stability, and functional outcomes were excellent for all patients. No patients had trigeminal or facial dysfunction. All had excellent cosmetic results as measured by post-reduction radiographs and personal and family perceptions of the forehead contour. Two patients had delayed wound healing and subsequent subclinical wound infections, which resolved after treatment with antibiotics for 2 weeks. Craniofacial skeletal reconstruction with 3-D titanium mesh results in excellent forehead contour and cosmesis, and subsequently a better quality of life with few complications. Titanium mesh reconstruction offers a favorable alternative to other graft materials in the repair of large skull defects.
authors.affiliation: Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
authors.forename: Woon-Man
authors.initials: WM
authors.lastname: Kung
authors.forename: Feng-Huei
authors.initials: FH
authors.lastname: Lin
authors.forename: Sheng-Huang
authors.initials: SH
authors.lastname: Hsiao
authors.forename: Wen-Ta
authors.initials: WT
authors.lastname: Chiu
authors.forename: Charng-Cherng
authors.initials: CC
authors.lastname: Chyau
authors.forename: Shing-Hwa
authors.initials: SH
authors.lastname: Lu
authors.forename: Betau
authors.initials: B
authors.lastname: Hwang
authors.forename: Jia-Hua
authors.initials: JH
authors.lastname: Lee
authors.forename: Muh-Shi
authors.initials: MS
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000601:surgery*; D017076:Computer-Aided Design; D056424:Decompressive Craniectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D013526:Surgical Mesh; D014025:Titanium / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014025:Titanium