Nagasao Tomohisa, Shinoda Jun, Horiguchi Takashi, Kishi Kazuo
Department of Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan.
J Craniofac Surg. 2011 Jan;22(1):84-8. doi: 10.1097/SCS.0b013e3181f6c587.
Defects of the dura mater caused by surgical intervention are often reconstructed using artificial substitutes such as polytetrafluoroethylene membrane (Gore-Tex in commercial name). In cases where secondary infection develops after the initial operation, the artificial substitute used in the primary surgery needs to be removed, and the cranial defect should be covered with tissues abundant in blood supply. The present study discusses the necessity of secondary reconstruction of the dural defect in the recovery operation.
A retrospective study was conducted on 12 patients in whom artificial substitute was exposed because of necrosis of the overlying tissues due to infection or radiation. In recovery operations, the artificial substitute was removed, and the conditions of the underlying defects were evaluated.
In all cases, capsule formation had developed to cover dural defects underneath the infected artificial substitutes. The capsules were transparent and watertight, presenting no leakage of cerebrospinal fluid. After coverage of the defect regions using free-flap transfer, no patient developed postoperative complications in follow-up periods of at least 6 months.
Capsule formation occurs under artificial substitutes after replacement of the dura mater. Because the capsules retain the cerebrospinal fluid, replacement of the artificial materials is unnecessary in the secondary operation.
手术干预导致的硬脑膜缺损通常使用人工替代品进行修复，如聚四氟乙烯膜（商品名为戈尔薄膜）。在初次手术后发生继发感染的情况下，需要移除初次手术中使用的人工替代品，并用血供丰富的组织覆盖颅骨缺损。本研究探讨了在修复手术中对硬脑膜缺损进行二次修复的必要性。
对12例因感染或放疗导致覆盖组织坏死而使人工替代品暴露的患者进行回顾性研究。在修复手术中，移除人工替代品，并评估其下方缺损的情况。
在所有病例中，均已形成包膜覆盖感染的人工替代品下方的硬脑膜缺损。这些包膜透明且防水，未出现脑脊液漏。在使用游离皮瓣转移覆盖缺损区域后，在至少6个月的随访期内，没有患者出现术后并发症。
硬脑膜置换后，人工替代品下方会形成包膜。由于这些包膜可保留脑脊液，因此在二次手术中无需更换人工材料。
