Dhaga Technique for Tissue Plane Preservation after Decompressive Craniectomy: Comparison of New Technique with Institutional Standard.
BACKGROUND
During cranioplasty after decompressive craniectomy, the temporalis muscle is firmly attached to the dural patch and intermixed with fibrotic tissue leading to considerable difficulty in dissecting the plane between the dura, galea and the temporalis muscle. This leads to increased surgical time, intraoperative blood loss, risk of complications and also affects rehabilitation. We have developed the "dhaga technique," which aids in preserving the plane between the muscle and dura in order to improve outcomes. Here we describe our technique and also compare the "dhaga technique" with the generally accepted standard procedure.


METHODS
A retrospective review was carried out of all patients undergoing cranioplasty following decompressive craniectomy either through the "dhaga technique" or the institutional standard (control group). Both techniques were compared using intra operative blood loss, duration of surgery and any complications as study variables.


RESULTS
There were 133 patients were included in the study. The control group included 68 patients who underwent the procedure according to institutional standard, and 65 patients were included in the "dhaga technique group." Both groups were well matched for baseline characteristics. Patients in the "dhaga technique" group had statistically significant lower operating time (P value = 0.037) and intra operative blood loss (P value = 0.025). However, there was no significant difference in complications.


CONCLUSIONS
The utilization of "dhaga technique" can potentially improve outcomes and reduce costs by decreasing operative time and blood loss. Moreover, the temporalis muscle preservation in the "dhaga technique" may also enhance aesthetic outcomes and chewing, which were not assessed in this study. There were no differences in complication between the two techniques.
Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Gohar
G
Javed
Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. Electronic address: Babarkhan08@gmail.com.
Muhammad Babar
MB
Khan
Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Syed Ijlal
SI
Ahmed
Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Manzar
M
Hussain
D000328:Adult; D016063:Blood Loss, Surgical / Q000503:physiopathology; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
Cranioplasty; Decompressive craniectomy; Dhaga technique; Raised intracranial pressure; Temporalis muscle preservation; Traumatic brain injury