title: Implantation of Thickened Artificial Bone for Reduction of Dead Space and Prevention of Infection Between Implant and Dura in Secondary Reconstruction of the Skull.
abstract: For the treatment of skull defect compensation after neurosurgery, a customized artificial bone is often employed owing to its toughness and the relative ease of producing cosmetically good result. However, implants are vulnerable to infection and removal of implant is sometimes necessary. Several other treatment options such as autologous bone graft or free flap are likely to be considered for the secondary reconstruction to avoid reinfection; however, reimplantation of artificial bone is beneficial for the patients, being not concerned with donor site morbidity. The authors consider one of risk factors of infection of artificial bone as dead space between the implant and dura. To attain reduction of the dead space, we have employed thickened artificial bone.Between 2010 and 2014, 6 patients underwent implantation of thickened artificial bone for the secondary reconstruction.First, the infected artificial material was removed with proper debridement. More than 3 months after the closure of the infected wound, tissue expander was inserted beneath the surrounding scalp to ensure the coverage of subsequently implanted artificial bone without skin tension. The thickened artificial bone was designed from the computed tomography findings so as not to leave any dead space between the implant and dura. After optimal expansion of the scalp, the artificial bone was implanted.Postoperative courses were uneventful and the appearance of the cranial vault was satisfactory in all patients.The authors consider the use of the thickened artificial bone is easier and more suitable for patients having a skull defect, particularly in secondary reconstruction.
authors.affiliation: Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Mine
authors.initials: M
authors.lastname: Ozaki
authors.forename: Keigo
authors.initials: K
authors.lastname: Narita
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kurita
authors.forename: Yuki
authors.initials: Y
authors.lastname: Iwashina
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takushima
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Harii
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000295:instrumentation / Q000379:methods; D000069343:Bone-Implant Interface; D003646:Debridement / Q000379:methods; D020878:Device Removal / Q000379:methods; D004388:Dura Mater / Q000601:surgery; D005260:Female; D058752:Free Tissue Flaps / Q000637:transplantation; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D012535:Scalp / Q000601:surgery; D012886:Skull / Q000601:surgery*