Two-Stage Cranioplasty: Tissue Expansion Directly over the Craniectomy Defect Prior to Cranioplasty.
Performing a skull reconstruction for a long-term existing large cranium defect usually needs either skin enhancement or skin flaps and cranioplasty. This procedure can be accompanied with aesthetic and functional complications. The presented case describes a 27-year-old man in need of a cranial reconstruction following decompressive craniectomy as treatment for severe traumatic brain injury. Autologous cranioplasty after decompressive craniectomy failed due to bone flap infection. Because of cognitive behavioral problems, a protective helmet needed to be worn in awaiting cranioplasty. The final titanium cranioplasty was placed subsequent to scalp expansion. The expansion was realized by placing a temporary and custom-made polymethylmethacrylate (PMMA) plate over the defect with a tissue expander on top of it, using the existing scar and skull defect. Our reported technique avoids additional skin flap creation and accompanied complications such as additional scalp and bone damage. In cognitive damaged patients who need to wear a helmet constantly, this simple method provides, concurrently, protection of the brain and tissue expansion. We demonstrate a successful novel technical manner to provide scalp enhancement by positioning a temporary PMMA graft over the skull defect and placing the tissue expander on top of it.
Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands.
Ellianne Jacira
EJ
Dos Santos Rubio
Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands.
Eelke M
EM
Bos
Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands.
Ruben
R
Dammers
Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia's Children's Hospital Rotterdam, Rotterdam, the Netherlands.
Maarten J
MJ
Koudstaal
Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Sophia's Children's Hospital Rotterdam, Rotterdam, the Netherlands.
Anton G
AG
Dumans
cranioplasty; decompressive craniectomy; temporary implant; tissue expander; trauma