DOI QR코드

DOI QR Code

Reconstruction of Chronic Complicated Scalp and Dural Defects Using Acellular Human Dermis and Latissimus Dorsi Myocutaneous Free flap

  • Lee, Jun Hee (Department of Plastic and Reconstructive Surgery, Kyung Hee University School of Medicine) ;
  • Choi, Seok Keun (Department of Neurosurgery, Kyung Hee University School of Medicine) ;
  • Kang, Sang Yoon (Department of Plastic and Reconstructive Surgery, Kyung Hee University School of Medicine)
  • Received : 2015.03.31
  • Accepted : 2015.08.04
  • Published : 2015.08.09

Abstract

We present reconstruction of a complicated scalp-dura defect using acellular human dermis and latissimus dorsi myocutaneous free flap. A 62-year-old female had previously undergone decompressive craniectomy for intracranial hemorrhage. The cranial bone flap was cryopreserved and restored to the original location subsequently, but necessitated removal for a methicillin-resistant Staphylococcal infection. However, the infectious nidus remained in a dermal substitute that was left over the cerebrum. Upon re-exploration, this material was removed, and frank pus was observed in the deep space just over the arachnoid layer. This was carefully irrigated, and the dural defect was closed with acellular dermal matrix in a watertight manner. The remaining scalp defect was covered using a free latissimus dorsi flap with anastomosis between the thoracodorsal and deep temporal arteries. The wound healed well without complications, and the scalp remained intact without any evidence of cerebrospinal fluid leak or continued infection.

Keywords

References

  1. Boeckx WD, van der Hulst RR, Nanhekhan LV, De Lorenzi F. The role of free flaps in the treatment of persistent scalp osteomyelitis. Neurosurgery 59(1 Suppl 1):ONS64-7.
  2. Warren WL, Medary MB, Dureza CD, Bellotte JB, Flannagan PP, Oh MY, et al. Dural repair using acellular human dermis: experience with 200 cases: technique assessment. Neurosurgery 2000;46:1391-6. https://doi.org/10.1097/00006123-200006000-00020
  3. Anson JA, Marchland EP. Bovine pericardium for dural grafts: Clinical results in 35 patients. Neurosurgery 1996;39:764-8. https://doi.org/10.1097/00006123-199610000-00025
  4. Xu BZ, Pan HX, Li KM, Chen XJ, Tian YD, Li YL, et al. Study and application of a porcine biomembrane for the repair of dural defects. J Neurosurg 1988;69:707-11. https://doi.org/10.3171/jns.1988.69.5.0707
  5. Girod A, Boissonnet H, Jouffroy T, Rodriguez J. Latissimus dorsi free flap reconstruction of anterior skull base defects. J Craniomaxillofac Surg 2012;40:177-9. https://doi.org/10.1016/j.jcms.2011.01.023
  6. Shridharani SM, Tufaro AP. A systematic review of acelluar dermal matrices in head and neck reconstruction. Plast Reconstr Surg 2012; 130(5 Suppl 2):35S-43S. https://doi.org/10.1097/PRS.0b013e31825eff7a

Cited by

  1. The use of human acellular dermal matrices in advanced wound healing and surgical procedures: State of the art vol.34, pp.4, 2015, https://doi.org/10.1111/dth.14987