title: Cranial Reconstruction following the Removal of an Infected Synthetic Dura Mater Substitute.
abstract: BACKGROUND
  The objective of this study was to describe the outcomes of an algorithmic approach to cranial reconstruction following the removal of an infected synthetic dura mater substitute due to postcraniotomy infection.
  
  
  METHODS
  A retrospective review was conducted of the cases of 12 patients who underwent cranial reconstruction from 2006 to 2013 after the removal of an infected expanded polytetrafluoroethylene sheet (a synthetic dura mater substitute) due to postcraniotomy infection.
  
  
  RESULTS
  Average patient age was 46 years (range, 19-70 years). Follow-up was 4.6 years. The expanded polytetrafluoroethylene sheets were implanted after decompressive craniectomy or after combined resection of the dura mater and a tumor. Epidural, but not subdural, abscesses were found in 6 patients, in whom a sufficient capsule developed underneath the synthetic dura mater. Both epidural and subdural abscesses were found in the remaining 6 patients, and the capsule remained intact after debridement of the subdural abscesses in half of them. Secondary cranial reconstruction was safely performed by leaving the capsule intact in the 9 cases in which no additional dural reconstruction was performed. In the remaining 3 patients, in whom no capsule remained after debridement, secondary cranial reconstruction was carried out by leaving the pericranium over the brain surface. None of the patients developed postoperative complications in follow-up periods.
  
  
  CONCLUSIONS
  Staged cranial reconstruction after the removal of an infected synthetic dura mater substitute using an algorithmic approach is feasible and safe, produces satisfactory cosmetic results, and is not associated with any complications.
authors.affiliation: Department of Craniofacial Surgery and Plastic Surgery, Tominaga Hospital, Osaka, Japan.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Yoshioka