title: Alloderm Covering Over Titanium Cranioplasty May Minimize Contour Deformities in the Frontal Bone Position.
abstract: BACKGROUND
  Titanium cranioplasty is commonly used for surgical closure of skull defects post craniectomy. Superficial implantation of the mesh can result in discomfort, palpability, and in extreme patients, exposure of the mesh. Exposed titanium mesh can be complicated by infections and often requires implant revision or removal. Generally, the contour of the titanium mesh is camouflaged in the hairline of the patient and any aesthetic complication can remain inconspicuous. However, in the frontal bone position the thin hairless forehead skin often may not easily hide the contour of the underlying titanium mesh.
  
  
  OBJECTIVE
  The goal of this study was to demonstrate the usage of an alloderm covering over the titanium cranioplasty to possibly minimize the contour irregularities of titanium.
  
  
  METHODS
  Our index patient, a 22-year-old woman, was operated for left frontal craniectomy for frontal bone tumor extending to brain parenchyma. This resulted in a surgical defect that was repaired with titanium mesh cranioplasty and dural patch. It was felt that the patient would potentially feel and see the titanium mesh cranioplasty under the thin frontalis muscle. Therefore, over top of the titanium mesh a remnant piece of AlloDerm unused after the dural patch was placed to buffer the potential contour deformity. Postoperatively, the contour appears natural and the patient does not report any complaints of discomfort or mesh palpability.
  
  
  CONCLUSIONS
  In a thin-skinned patient undergoing titanium mesh cranioplasty, the risk of mesh palpability or exposure can be significant, especially in areas of non-hair-bearing scalp and the protruding areas of the skull. Alloderm covering over the titanium mesh can provide improved aesthetic outcomes by minimizing contour deformity and may serve as an additional buffer in thin scalp.
authors.affiliation: *Division of Plastic Surgery, Department of Surgery †Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Mansher
authors.initials: M
authors.lastname: Singh
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Ricci
authors.forename: Ian F
authors.initials: IF
authors.lastname: Dunn
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Caterson
mesh_terms: D003094:Collagen; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D005624:Frontal Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D013526:Surgical Mesh; D014025:Titanium; D055815:Young Adult
chemical_list: C440568:Alloderm; D003094:Collagen; D014025:Titanium