Lo Andrea Y, Yu Roy P, Raghuram Anjali C, Cooper Michael N, Thompson Holly J, Liu Charles Y, Wong Alex K
Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of South California, Los Angeles, California.
Wilson Dental Library, Herman Ostrow School of Dentistry of University of South California, Los Angeles, California.
Arch Plast Surg. 2022 Dec 13;49(6):729-739. doi: 10.1055/s-0042-1751104. eCollection 2022 Nov.
Cranioplasties are common procedures in plastic surgery. The use of tissue expansion (TE) in staged cranioplasties is less common. We present two cases of cranioplasties with TE and systematically review literature describing the use of TE in staged cranioplasties and postoperative outcomes. A systematic review was performed by querying multiple databases. Eligible articles include published case series, retrospective reviews, and systematic reviews that described use of TE for staged bony cranioplasty. Data regarding study size, patient demographics, preoperative characteristics, staged procedure characteristics, and postoperative outcomes were collected. Of 755 identified publications, 26 met inclusion criteria. 85 patients underwent a staged cranioplasty with TE. Average defect size was 122 cm , and 30.9% of patients received a previous reconstruction. Average expansion period was 14.2 weeks. The most common soft tissue closures were performed with skin expansion only (75.3%), free/pedicled flap (20.1%), and skin graft (4.7%). The mean postoperative follow-up time was 23.9 months. Overall infection and local complication rates were 3.53 and 9.41%, respectively. The most common complications were cerebrospinal fluid leak (7.1%), hematoma (7.1%), implant exposure (3.5%), and infection (3.5%). Factors associated with higher complication rates include the following: use of alloplastic calvarial implants and defects of congenital etiology ( = 0.023 and 0.035, respectively). This is the first comprehensive review to describe current practices and outcomes in staged cranioplasty with TE. Adequate soft tissue coverage contributes to successful cranioplasties and TE can play a safe and effective role in selected cases.
颅骨修复术是整形手术中的常见操作。在分期颅骨修复术中使用组织扩张术（TE）的情况较少见。我们报告了两例采用组织扩张术的颅骨修复病例，并系统回顾了描述在分期颅骨修复术中使用组织扩张术及术后结果的文献。通过查询多个数据库进行了系统回顾。符合条件的文章包括已发表的病例系列、回顾性综述以及描述使用组织扩张术进行分期骨性颅骨修复术的系统综述。收集了有关研究规模、患者人口统计学特征、术前特征、分期手术特征及术后结果的数据。在755篇已识别的出版物中，26篇符合纳入标准。85例患者接受了采用组织扩张术的分期颅骨修复术。平均缺损面积为122平方厘米，30.9%的患者曾接受过先前的修复手术。平均扩张期为14.2周。最常见的软组织闭合方式仅为皮肤扩张（75.3%）、游离/带蒂皮瓣（20.1%）和植皮（4.7%）。术后平均随访时间为23.9个月。总体感染率和局部并发症发生率分别为3.53%和9.41%。最常见的并发症为脑脊液漏（7.1%）、血肿（7.1%）、植入物外露（3.5%）和感染（3.5%）。与较高并发症发生率相关的因素如下：使用异体颅骨植入物和先天性病因导致的缺损（分别为P = 0.023和0.035）。这是第一篇全面描述采用组织扩张术的分期颅骨修复术当前实践及结果的综述。充足的软组织覆盖有助于颅骨修复术的成功，并且组织扩张术在特定病例中可发挥安全有效的作用。
