title: Reconstruction of a large calvarial traumatic defect using a custom-made porous hydroxyapatite implant covered by a free latissimus dorsi muscle flap in an 11-year-old patient.
abstract: Reconstruction of complex skull defects requires collaboration between neurosurgeons and plastic surgeons to choose the most appropriate procedure, especially in growing children. The authors describe herein the reconstruction of an extensive traumatic bone and soft tissue defect of the cranial vault in an 11-year-old boy. The size of the defect, quality of the tissues, and patient's initial condition required a 2-stage approach. Ten months after an initial emergency procedure in which lacerated bone and soft tissue were excised, reconstruction was performed. The bone defect, situated on the left frontoparietal region, was 85 cm2and was filled by a custom-made porous hydroxyapatite implant. The quality of the overlying soft tissue did not allow the use of classic local and locoregional coverage techniques. A free latissimus dorsi muscle flap branched on the contralateral superficial temporal pedicle was used and left for secondary healing to take advantage of scar retraction and to minimize alopecia. Stable well-vascularized implant coverage as well as an esthetically pleasing skull shape was achieved. Results in this case suggest that concomitant reconstruction of large calvarial defects by cranioplasty with a custom-made hydroxyapatite implant covered by a free latissimus dorsi muscle flap is a safe and efficient procedure in children, provided that there is no underlying infection of the operative site.
authors: APHP, Hôpital Necker Enfants Malades, Service de chirurgie maxillo-faciale, Paris.|Department of Neurosurgery, Necker Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors: Anne
authors: A
authors: Morice
authors: Institut Gustave Roussy, Département de cancérologie cervico-faciale, Service de chirurgie plastique, Villejuif.
authors: Frédéric
authors: F
authors: Kolb
authors: APHP, Hôpital Necker Enfants Malades, Service de chirurgie maxillo-faciale, Paris.|Université Paris Descartes, Paris.|Centre de références des malformations de la face et de la cavité buccale, Paris; and.
authors: Arnaud
authors: A
authors: Picard
authors: APHP, Hôpital Necker Enfants Malades, Service de chirurgie maxillo-faciale, Paris.|Université Paris Descartes, Paris.|Centre de références des malformations de la face et de la cavité buccale, Paris; and.
authors: Natacha
authors: N
authors: Kadlub
authors: Department of Neurosurgery, Necker Hospital, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors: Stéphanie
authors: S
authors: Puget
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D017886:Durapatite / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D016062:Porosity; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D012886:Skull / Q000293:injuries / Q000601:surgery*; D064171:Superficial Back Muscles / Q000637:transplantation*; D013524:Surgical Flaps / Q000637:transplantation*
chemical_list: D017886:Durapatite
keywords: CP = cranioplasty; DC = decompressive craniectomy; FRC = glass fiber–reinforced composite; HA = hydroxyapatite; PEEK = polyetheretherketone; PMMA = polymethylmethacrylate; cranioplasty; custom-made hydroxyapatite implant; free latissimus dorsi muscle flap; scalp scars; surgical technique; trauma; traumatic skull defects