Cranial reconstruction after a post-craniotomy empyema

Summary This article presents a case report of a cranioplasty performed after a post-craniotomy empyema with osteitis. The skull reconstruction was performed using a bioceramic implant and a combined muscular free flap of latissimus dorsi and serratus anterior. This procedure not only provided cover...

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Bibliographic Details
Published in:Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2009-06, Vol.62 (6), p.e131-e135
Main Authors: Chabas, J.-F, Dellavolpe, C, Riah, Y, Bron, T, Reynier, Y, Kaya, J.-M, Casanova, D
Format: Article
Language:English
Subjects:
Adult
Bioceramic implant
Bone Substitutes - therapeutic use
Brain Diseases - surgery
Cerebral empyema
Cranioplasty
Craniotomy - adverse effects
Empyema - surgery
Female
Humans
Life Sciences
Muscular free flap
Neurons and Cognition
Plastic Surgery
Reconstructive Surgical Procedures - methods
Skull - surgery
Surgical Flaps
Surgical Wound Infection - surgery
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Summary:Summary This article presents a case report of a cranioplasty performed after a post-craniotomy empyema with osteitis. The skull reconstruction was performed using a bioceramic implant and a combined muscular free flap of latissimus dorsi and serratus anterior. This procedure not only provided coverage of a wide skull defect but also allowed the filling of the intracranial dead space. Clinically, we observed an improvement of the patient's preoperative neurological status with a near-complete correction of her right hemiparaesis and phasic disorders. Eight months after the cranioplasty, (1) no recurrence of infection was noticed; (2) no distortion of the skull was noticeable and (3) the patient again experienced a normal social life. Using computed tomography (CT) scan images, we observed a re-expansion of the left cerebral hemisphere without any dead space or extradural collection. The only observable sequelae were a temporoparietal alopecia (10 cm × 4 cm) and a winging of the scapula, induced by the skin graft and the removal of the lower-third of the serratus anterior muscle, respectively. The use of a muscular free flap associated with a customised biomaterial allows a single-stage reconstruction of extensive skull defect (120 cm2 ) in a previously infected area.
ISSN:1748-6815
1878-0539
DOI:10.1016/j.bjps.2008.10.001