Archives of Reconstructive Microsurgery
- 제18권1호
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- Pages.23-26
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- 2009
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- 2383-5257(pISSN)
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- 2288-6184(eISSN)
대퇴근막 이식과 전외측 대퇴 유리 피판을 이용한 난치성 경막 외 농양의 치료
The Treatment for The Intractable Epidural Abscess Using Tensor Fascia Lata Graft and Anterolateral Thigh Free Flap
- 박병찬 (영남대학교 의과대학 성형외과학교실) ;
- 류민희 (좋은문화병원 미용성형재건센터) ;
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김태곤
(영남대학교 의과대학 성형외과학교실) ;
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이준호
(영남대학교 의과대학 성형외과학교실)
- Park, Byung-Chan (Department of Plastic & Reconstructive Surgery, College of Medicine Yeungnam University) ;
- Ryu, Min-Hee (Aesthetic, Plastic and Reconstructive Surgery Center, Good Munhwa Hospital) ;
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Kim, Tae-Gon
(Department of Plastic & Reconstructive Surgery, College of Medicine Yeungnam University) ;
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Lee, Jun-Ho
(Department of Plastic & Reconstructive Surgery, College of Medicine Yeungnam University)
- 발행 : 2009.05.31
초록
Purpose: Artificial dura maters are commonly used in cranioplasty, but sometimes they can result in serious postoperative infection. Once complications such as epidural abscess or chronic draining ulcer arise, they are very difficult to treat. In this case, reclosure of dura defect using artificial dura mater may give rise to recurrence of infection. We experienced a case of intractable epidural abscess caused by use of artificial dura. To avoid repeated infection, we decided to use autologous tissue for the coverage of dura and soft tissue defect. Therefore, autologous tensor fascia lata graft and anterolateral thigh free flap were harvested at the same donor site incision to cover composite defect on the scalp and dura mater. Methods: A 13 year old male patient, who underwent the decompression cranioplasty and duroplasty, suffered from the intractable infection lesion. Twice, the epidural abscess was removed, both times the infection recurred. And eventually dura mater was exposed through the infected open wound. Nine months after dura exposed, infected aritificial dura mater was removed and extensive debridement was performed. Through a surgical incision on donor thigh, first, tensor fascia lata graft was harvested in process of the anterolateral thigh flap elevation. After the fascia lata graft was fixed over the dural defect, the anterolateral thigh flap was used to fill the dead space as well as the scalp defect. Results: Postoperatively, no recurrent infection and cerebrospinal fluid leakage are observed for a year. After the surgery, on the first and second day, venous congestion of the flap was observed, this problem was solved by thrombectomy and vein reanastomosis. And partial necrosis of flap occurred, but completely healed as conservative treatment for two weeks. Conclusion: Using the autologous tensor fascia lata graft and anterolateral thigh flap, we could obtain satisfactory results as treatment for the intractable infection lesion after duroplasty. Autologous tensor fascia lata in conjunction with anterolateral thigh flap is useful method for covering composite defect of scalp and dura mater.