Nakahara Kuniaki, Ikemoto Shigehiro, Shimizu Satoru, Yamada Masaru, Kumabe Toshihiro
Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan,
Childs Nerv Syst. 2014 Jul;30(7):1283-6. doi: 10.1007/s00381-014-2406-7. Epub 2014 May 4.
Although distraction osteogenesis has been widely accepted to treat craniosynostosis, it occasionally results in wound complications. Positing that they are attributable to the tense pericranium under the scalp, we developed a simple technique to relax the pericranial flap.
In 12- to 15-month-old infants (mean 13 months), we placed a coronal skin incision and dissected the scalp at the subgaleal layer. Then, we peeled the intact pericranium away from the skull along the planned osteotomy to obtain flaps with pedicles on the caudal part. After osteotomy and setting of the distraction device, the pericranial flaps freed from the scalp flap were repositioned to fit the osteotomy line, dura, and distraction device. The galea and skin were approximated layer by layer.
The shape of the skull was successfully corrected, and the bone defect created by expansion was filled by osteogenesis in all patients. During a mean follow-up period of 42.2 months, we encountered no wound complications.
The replaced relaxed pericranium closely adhered to the osteotomy, and the distraction device facilitated vascular growth and bone restoration. Bone resorption was prevented and skin expansion promoted. In patients with iatrogenic dural injury, the pericranium over the injured dura serves as a barrier to prevent cerebrospinal fluid leakage.
尽管牵引成骨术已被广泛用于治疗颅缝早闭，但偶尔会导致伤口并发症。鉴于这些并发症归因于头皮下紧张的颅骨膜，我们开发了一种简单的技术来放松颅骨膜瓣。
在12至15个月大的婴儿（平均13个月）中，我们做了冠状皮肤切口，并在帽状腱膜下层解剖头皮。然后，我们沿着计划的截骨线将完整的颅骨膜从颅骨上剥离，以获得在尾部带有蒂的皮瓣。截骨并安装牵引装置后，将从头皮瓣游离的颅骨膜瓣重新定位，以贴合截骨线、硬脑膜和牵引装置。帽状腱膜和皮肤逐层缝合。
所有患者的颅骨形状均成功矫正，扩张造成的骨缺损通过骨生成得以填充。在平均42.2个月的随访期内，我们未遇到伤口并发症。
复位的松弛颅骨膜紧密附着于截骨处，牵引装置促进了血管生长和骨修复。防止了骨吸收并促进了皮肤扩张。在医源性硬脑膜损伤的患者中，损伤硬脑膜上方的颅骨膜可作为防止脑脊液漏出的屏障。
