title: Vacuum-assisted closure of necrotic and infected cranial wound with loss of dura mater: A technical note.
abstract: BACKGROUND
  Complex cranial wounds can be a problematic occurrence for surgeons. Vacuum-assisted closure devices have a wide variety of applications and have recently been used in neurosurgical cases involving complex cranial wounds. There is only one report regarding the use of a vacuum-assisted closure device with loss of dura mater. We report a complicated case of a necrotic cranial wound with loss of dura mater.
  
  
  METHODS
  A 68-year-old female underwent an evacuation of a subdural hematoma. Postoperatively, the patient developed a wound infection that required removal of the bone flap. The wound developed a wedge-shaped necrosis of the scalp with exposure of brain tissue due to loss of dura mater from previous surgeries. She underwent debridement and excision of the necrotic tissue with placement of a synthetic dural graft (Durepair®, Medtronic, Inc.) and placement of a wound vac. The patient underwent a latissismus dorsi muscle flap reconstruction that subsequently failed. After the wound vac was replaced, the synthetic dural graft was replaced with a fascia lata graft and an anterolateral thigh free flap reconstruction. We describe the technical nuances of this complicated case, how the obstacles were handled, and the literature that discusses the utility.
  
  
  CONCLUSIONS
  We describe a case of a complex cranial wound and technical nuances on how to utilize a wound-vac with loss of dura mater.
authors: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors: Osama
authors: O
authors: Ahmed
authors: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors: Christopher M
authors: CM
authors: Storey
authors: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors: Shihao
authors: S
authors: Zhang
authors: Department of Orthopedic Surgery/Plastic and Hand Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors: Marjorie R
authors: MR
authors: Chelly
authors: Department of Oral and Maxillofacial Surgery/Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors: Melvin S
authors: MS
authors: Yeoh
authors: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors: Anil
authors: A
authors: Nanda
keywords: Infection; necrosis; subdural hematoma; vacuum-assisted closure
references: Wound Repair Regen. 2006 May-Jun;14(3):371-4
references: 16808818
references: Ann Plast Surg. 1997 Jun;38(6):563-76; discussion 577
references: 9188971
references: Ann Plast Surg. 2005 Dec;55(6):665-71
references: 16327472
references: Lancet. 2005 Nov 12;366(9498):1704-10
references: 16291063
references: Spine (Phila Pa 1976). 2001 Feb 1;26(3):E30-3
references: 11224876
references: Plast Reconstr Surg. 2009 Jan;123(1):19e-21e
references: 19116512
references: Eur J Cardiothorac Surg. 2006 Dec;30(6):898-905
references: 17056269
references: J Trauma. 2006 Jun;60(6):1301-6
references: 16766975
references: Zhonghua Zheng Xing Wai Ke Za Zhi. 2003 Jul;19(4):279-81
references: 14628418
references: J Wound Care. 2005 May;14(5):224-7
references: 15909439
references: Plast Reconstr Surg. 2001 Dec;108(7):2066-8
references: 11743402
references: J Craniofac Surg. 2008 Nov;19(6):1577-82
references: 19098555
references: J Neurosurg. 2013 Feb;118(2):302-8
references: 23157181
references: Neurosurgery. 2011 May;68(5):E1481-3; discussion E1484
references: 21307788
references: Arch Surg. 2002 Aug;137(8):930-3; discussion 933-4
references: 12146992
references: Zentralbl Chir. 2004 May;129 Suppl 1:S59-61
references: 15168289
references: Ann Plast Surg. 2006 Apr;56(4):418-22
references: 16557076
references: Ann Vasc Surg. 2003 Nov;17(6):645-9
references: 14534844
references: J Spinal Disord Tech. 2008 Jul;21(5):320-3
references: 18600140
references: Burns. 2004 May;30(3):253-8
references: 15082354
references: J Vasc Surg. 2006 Nov;44(5):1029-37; discussion 1038
references: 17000077
references: Gynecol Oncol. 2004 Feb;92(2):586-91
references: 14766251
references: Wound Repair Regen. 2004 Nov-Dec;12(6):600-6
references: 15555050
references: Ann Plast Surg. 2002 Jul;49(1):55-61; discussion 61
references: 12142596
references: J Hand Surg Br. 2003 Aug;28(4):381-3
references: 12849953
references: Postgrad Med J. 2002 Jun;78(920):364-5
references: 12151694
references: Plast Reconstr Surg. 2002 Feb;109(2):710-2
references: 11818858
references: Ann Thorac Surg. 2005 Oct;80(4):1270-5
references: 16181853
references: Head Neck. 2006 Nov;28(11):974-81
references: 16983694
references: Br J Plast Surg. 2001 Jun;54(4):363-5
references: 11355997
references: J Spinal Disord Tech. 2005 Feb;18(1):14-7
references: 15687846
references: Obstet Gynecol. 2002 Mar;99(3):497-501
references: 11864680
references: Ann Plast Surg. 1997 Jun;38(6):553-62
references: 9188970