Nakano Takashi, Yoshikawa Katsuhiro, Kunieda Takeharu, Arakawa Yoshiki, Kikuchi Takayuki, Yamawaki Satoko, Naitoh Motoko, Kawai Katsuya, Suzuki Shigehiko
From the Departments of *Plastic and Reconstructive Surgery, and † Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Craniofac Surg. 2014 Jul;25(4):1252-5. doi: 10.1097/SCS.0000000000000929.
Synthetic artificial dura mater materials, such as expanded polytetrafluoroethylene sheets, are widely used in dura mater reconstruction in cases involving brain tumors or trauma surgery. In patients with postoperative infection related to the use of artificial dura mater, surgical debridement of the infected wound and removal of the artificial dura mater materials are necessary to control infection. In cases involving cerebrospinal fluid leakage, dura mater reconstruction must be performed immediately. Many useful techniques for performing dura mater reconstruction to treat postoperative infection have been reported; however, some have drawbacks with respect to the need for microvascular anastomosis or difficulties in obtaining watertight closure. We successfully treated 6 patients with postoperative artificial dura mater infection using free thigh fascia lata. Some surgeons believe that the use of free fascia in infected wounds is dangerous because free fascia is a non-vascularized tissue. However, performing complete debridement and covering such free fascia with well-vascularized tissue allow the fascia to become vascularized and tolerant of infection. Therefore, if the blood flow in the scalp is acceptable after a sufficient debridement, free fascia lata can be used for reconstruction in patients with postoperative infection of artificial dura mater. Furthermore, skull reconstruction can be performed safely and easily with solid-type artificial bone, sometimes combined with tissue expansion, thus resulting in good aesthetic outcomes.
合成人工硬脑膜材料，如膨体聚四氟乙烯片，广泛应用于脑肿瘤或创伤手术等病例的硬脑膜重建。在与使用人工硬脑膜相关的术后感染患者中，对感染伤口进行手术清创并去除人工硬脑膜材料对于控制感染是必要的。在涉及脑脊液漏的病例中，必须立即进行硬脑膜重建。已经报道了许多用于进行硬脑膜重建以治疗术后感染的有用技术；然而，一些技术在微血管吻合的必要性或实现水密闭合的困难方面存在缺点。我们使用游离阔筋膜成功治疗了6例人工硬脑膜术后感染患者。一些外科医生认为在感染伤口中使用游离筋膜是危险的，因为游离筋膜是无血管化组织。然而，进行彻底清创并用血管化良好的组织覆盖这种游离筋膜可使筋膜血管化并耐受感染。因此，如果在充分清创后头皮血流可接受，则游离阔筋膜可用于人工硬脑膜术后感染患者的重建。此外，使用实体型人工骨有时结合组织扩张可以安全、轻松地进行颅骨重建，从而获得良好的美学效果。
