New technique of decompressive skinplasty with artificial dermis for severe brain swelling: technical note.
In cases of severe uncontrollable brain swelling, simple skin closure often increases intracranial pressure. This study examined the efficacy of a new technique of decompressive skinplasty to decrease intracranial pressure following decompressive craniectomy in cases of severe traumatic brain injury with uncontrollable brain swelling. In our technique, we use artificial dermis to avoid elevation of intracranial pressure. After performing decompressive craniectomy and duraplasty with artificial dura, decompressive skinplasty with artificial dermis was performed in 5 patients for whom simple skin closure caused the intracranial pressure to elevate under intracranial pressure monitoring. Artificial dermis was grafted onto the region to cover the skin defect and sutured to the skin with 4-0 nylon sutures. Two weeks after surgery, the silicone layer of the artificial dermis was removed and ointment treatment was continued until complete epithelialization was achieved. In all cases, decompressive skinplasty contributed dramatically to decreasing the intracranial pressure in patients with uncontrollable brain swelling. The technique of decompressive skinplasty with artificial dermis contributed to dramatically decreasing the intracranial pressure. More cases are required to investigate the indications for this technique.
Department of Neurosurgery, Hyogo Prefectural Kakogawa Medical Center, Kagogawa, Hyogo, Japan. nakutsu@med.kobe-u.ac.jp
Nobuyuki
N
Akutsu
Hideo
H
Aihara
Atsushi
A
Sakurai
Junko
J
Kusaka
Michinori
M
Yasuda
Eiji
E
Kohmura
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D001929:Brain Edema / Q000503:physiopathology / Q000601:surgery*; D001930:Brain Injuries / Q000503:physiopathology / Q000601:surgery*; D003094:Collagen; D056424:Decompressive Craniectomy / Q000379:methods*; D015600:Glasgow Coma Scale; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D017768:Skin, Artificial; D013536:Suture Techniques
D003094:Collagen