Ozaki Mine, Narita Keigo, Kurita Masakazu, Iwashina Yuki, Takushima Akihiko, Harii Kiyonori
Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
J Craniofac Surg. 2017 Jun;28(4):888-891. doi: 10.1097/SCS.0000000000003507.
For the treatment of skull defect compensation after neurosurgery, a customized artificial bone is often employed owing to its toughness and the relative ease of producing cosmetically good result. However, implants are vulnerable to infection and removal of implant is sometimes necessary. Several other treatment options such as autologous bone graft or free flap are likely to be considered for the secondary reconstruction to avoid reinfection; however, reimplantation of artificial bone is beneficial for the patients, being not concerned with donor site morbidity. The authors consider one of risk factors of infection of artificial bone as dead space between the implant and dura. To attain reduction of the dead space, we have employed thickened artificial bone.Between 2010 and 2014, 6 patients underwent implantation of thickened artificial bone for the secondary reconstruction.First, the infected artificial material was removed with proper debridement. More than 3 months after the closure of the infected wound, tissue expander was inserted beneath the surrounding scalp to ensure the coverage of subsequently implanted artificial bone without skin tension. The thickened artificial bone was designed from the computed tomography findings so as not to leave any dead space between the implant and dura. After optimal expansion of the scalp, the artificial bone was implanted.Postoperative courses were uneventful and the appearance of the cranial vault was satisfactory in all patients.The authors consider the use of the thickened artificial bone is easier and more suitable for patients having a skull defect, particularly in secondary reconstruction.
对于神经外科手术后颅骨缺损的修复治疗，常采用定制人工骨，因其具有韧性且相对容易获得美观的效果。然而，植入物容易感染，有时需要取出植入物。对于二次重建，可能会考虑其他几种治疗选择，如自体骨移植或游离皮瓣，以避免再次感染；然而，重新植入人工骨对患者有益，因为无需担心供区并发症。作者认为人工骨感染的危险因素之一是植入物与硬脑膜之间的死腔。为了减少死腔，我们采用了加厚人工骨。2010年至2014年期间，6例患者接受了加厚人工骨植入进行二次重建。首先，通过适当的清创术取出感染的人工材料。感染伤口闭合3个月后，在周围头皮下插入组织扩张器，以确保随后植入的人工骨在无皮肤张力的情况下得到覆盖。根据计算机断层扫描结果设计加厚人工骨，使植入物与硬脑膜之间不留任何死腔。头皮充分扩张后，植入人工骨。所有患者术后病程平稳，颅顶外观满意。作者认为，使用加厚人工骨对颅骨缺损患者来说更容易且更合适，尤其是在二次重建中。
