Reiss Ségolène, Zemmoura Ilyess, Joly Aline, Kün-Darbois Jean-Daniel, Laure Boris, Paré Arnaud
Department of Maxillofacial and Facial Plastic Surgery, Trousseau Hospital, University Hospital Center of Tours, Tours, France.
Department of Neurosurgery, Bretonneau Hospital, University Hospital Center of Tours, Tours, France; University of François Rabelais, School of Medicine, Tours, France; UMR 1253, iBrain, University of Tours, Inserm, Tours, France.
World Neurosurg. 2019 Feb;122:210-214. doi: 10.1016/j.wneu.2018.10.184. Epub 2018 Nov 4.
Infection and skin fistula are well-known complications after cranioplasty leading to reconstruction exposure and usually requiring new surgical procedure with poor condition for cutaneous closure. We describe 2 cases using muscle forehead flap (MFF) to treat skin fistula and cranioplasty exposure.
The first case was a 43-year-old man who underwent a calvarial bone graft of the frontal sinus anterior wall after craniofacial trauma. Three months postoperatively, osteitis of the bone reconstruction and a skin fistula occurred in the median frontal region. The second case was a 37-year-old woman treated for a cingular glioblastoma by 3 surgeries, concomitant chemoradiation therapy, and frontal reconstruction using a titanium plate. She presented a plate exposure associated with cerebrospinal fluid leak and meningitis. Both patients were successfully treated by surgical removal of the frontal cranioplasty and skin closure using MFF. We observed a satisfying cosmetic result with no recurrence of infection or fistula at 12 and 4 months, respectively.
MFF is a surgical option to treat complex cases of cutaneous fistula secondary to cranioplasty exposure of the anterior cranial fossa.
