title: "Countersinking" of reservoir in an irradiated patients can decrease tension on scalp closure.
abstract: BACKGROUND
  Subcutaneous reservoirs are used to provide therapy by establishing access to cerebrospinal fluid. However, it is associated with complications such as hemorrhage, infection, malfunction, and malpositioning. In an irradiated field with thin skin, use of reservoir can result in wound dehiscence, wound infection, and device extrusion.
  
  
  METHODS
  We introduced a "countersinking" technique for the reservoir placement which involves the creation of bony recess in the skull to effectively accommodate the reservoir and decrease the protrusion. "Countersinking" of the reservoir can result in tension-free closure of the scalp and allow durable coverage of the reservoir. In the representative case, the incisional wound healed completely without any concern for wound dehiscence and the countersink technique may have contributed to effective healing of the radiated scalp.
  
  
  CONCLUSIONS
  Countersinking of the reservoir can be a strategy to prevent complications such as wound dehiscence, and device extrusion in any patient, but in irradiated patients with very thin skin it also enables tension-free closure of the wound.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Mansher
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Arturo J
authors.initials: AJ
authors.lastname: Rios Diaz
authors.affiliation: Departmant of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Golby
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Caterson
keywords: Countersinking; ommaya reservoir; wound dehiscence