title: Vacuum-assisted closure therapy to the brain: a safe method for wound temporization in composite scalp and calvarial defects.
abstract: BACKGROUND
  When composite scalp and calvarial defects with dural or cortical brain exposure are encountered, active infection or indeterminate oncologic margins complicate the timing of scalp reconstruction. The purpose of this study was to evaluate the safety and efficacy of vacuum-assisted closure (VAC) therapy as a temporizing measure in these complex scalp defects with dural or cortical brain exposure and a hostile local wound environment.
  
  
  METHODS
  From December 2012 to December 2013, all composite scalp and calvarial defects reconstructed by the senior author (D.S.) were reviewed and 10 cases were identified. Five of these cases were temporized with VAC therapy. The medical records of these patients were reviewed.
  
  
  RESULTS
  Five patients (mean age, 66.2 years) with composite scalp and calvarial defects were temporized with VAC therapy. The indications for delay included gross wound infection in 4 patients and an indeterminate intraoperative oncologic margin. The average size of the scalp and calvarial defects measured 123 and 49 cm, respectively. One patient underwent VAC therapy over exposed cortical brain with a dural defect measuring 25 cm. The average time between the initial operation and definitive reconstruction was 4.8 days. The average daily VAC output was 74 mL. Reconstructive methods included 1 free flap, 2 scalp rotational advancement flaps, and readvancement of 2 prior free flaps. At an average follow-up of 32 weeks, 1 patient developed a subcentimeter postoperative wound breakdown that was treated successfully with an incisional VAC.
  
  
  CONCLUSIONS
  We found the use of VAC therapy applied directly to the dura or cortical brain as a safe and effective technique for short-term wound temporization in the setting of indeterminate oncologic margins or active infection.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, and †Department of Neurosurgery, University of Florida School of Medicine, Gainesville, FL; ‡Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan; §Division of Surgical Oncology, Department of Surgery, and ∥Department of Otolaryngology, University of Florida School of Medicine, Gainesville, FL.
authors.forename: Noah
authors.initials: N
authors.lastname: Prince
authors.forename: Spiros
authors.initials: S
authors.lastname: Blackburn
authors.forename: Gregory
authors.initials: G
authors.lastname: Murad
authors.forename: Bruce
authors.initials: B
authors.lastname: Mast
authors.forename: Stamatis
authors.initials: S
authors.lastname: Sapountzis
authors.forename: Christiana
authors.initials: C
authors.lastname: Shaw
authors.forename: John
authors.initials: J
authors.lastname: Werning
authors.forename: Dhruv
authors.initials: D
authors.lastname: Singhal
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D017063:Outcome Assessment, Health Care; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012535:Scalp / Q000601:surgery*; D012886:Skull / Q000601:surgery*; D013524:Surgical Flaps