Tringali Giovanni, D'Ammando Antonio, Bono Beatrice, Colombetti Anna, Franzini Angelo
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
World Neurosurg. 2019 Jun;126:502-507. doi: 10.1016/j.wneu.2019.02.247. Epub 2019 Mar 20.
Head trauma and neurosurgical-related osteomyelitis are common causes of cranial bone defect. Even though cranioplasty is considered a safe and well-consolidated procedure, there are still some issues about the flap's vascularization assessment. In this paper we describe a 2-staged cranioplasty procedure, focusing on the perioperative evaluation of the skin flap vascularization. Our goal is to assess if the skin flap's perfusion measurement with indocyanine green fluorescence can be considered a reliable method to predict good outcome in cranioplasties.
A 50-year-old patient presented with a wide frontal bone defect due to a prior surgery-related osteomyelitis. During the first operation, a tissue expander was placed under the scalp in order to grant an appropriate skin stretching. During the second operation the defect was repaired with a custom-made prosthesis after tissue expander removal. During all procedures, vascular integrity of the skin flap was intraoperatively assessed by means of indocyanine green fluorescence.
Surgical procedures were well tolerated; at 1 year of follow-up the cosmetic defect was unremarkable. Indocyanine green fluorescence can be a good aid to predict the probability of the skin flap survival by measuring its perfusion.
