Kessler Institute for Rehabilitation, Department of Physical Medicine and Rehabilitation, West Orange, New Jersey, USA.
Sunnyview Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Schenectady, New York, USA.
Brain Inj. 2024 Jan 28;38(2):61-67. doi: 10.1080/02699052.2024.2309261. Epub 2024 Feb 9.
Sunken Skin Flap Syndrome (SSFS) is an uncommon, delayed complication after craniectomy characterized by a functional plateau or decline with variable neurologic symptoms, improving after cranioplasty. SSFS negatively impacts the rehabilitation course, with subjective reports of functional improvement after cranioplasty. However, no studies have assessed the impact of cranioplasty on functional recovery rate. This case series aims to analyze SSFS manifestations and management while awaiting cranioplasty. Also, to assess the role of cranioplasty on rehabilitation outcomes and recovery rate in SSFS patients.
Four patients were identified with SSFS in inpatient rehabilitation. Each patient had unique clinical manifestations, with multiple strategies used for symptomatic control. Patients spent an average of 23 days in rehabilitation with SSFS symptoms before cranioplasty. After cranioplasty, all patients had SSFS symptom resolution. Comparing change in functional independence measure (FIM) scores and FIM efficiency pre-and post-cranioplasty rehabilitation course, a mean improvement of 23 and 0.72 occurred after cranioplasty, respectively.
A diagnosis of SSFS should be considered in craniectomy patients exhibiting functional decline or plateau with associated neurological symptoms. This study suggests that FIM and FIM efficiency increases in SSFS patients after cranioplasty, supporting prompt cranioplasty to improve functional outcomes and minimize rehabilitation delays.
颅骨切除术术后出现的陷皮瓣综合征（SSFS）是一种罕见的迟发性并发症，其特征为功能平台或下降伴有不同的神经症状，在颅骨修补术后改善。SSFS 对康复过程有负面影响，颅骨修补术后有功能改善的主观报告。然而，尚无研究评估颅骨修补术对功能恢复率的影响。本病例系列旨在分析颅骨修补术前 SSFS 的表现和处理方法，同时评估颅骨修补术对 SSFS 患者康复结局和恢复率的作用。
在住院康复中确定了 4 名 SSFS 患者。每位患者均有独特的临床表现，采用多种策略进行对症治疗。在颅骨修补术前，每位患者在康复期间均有 SSFS 症状，平均持续 23 天。颅骨修补术后，所有患者的 SSFS 症状均得到缓解。比较颅骨修补术前和术后康复过程中功能独立性测量（FIM）评分和 FIM 效率的变化，颅骨修补术后分别平均改善 23 分和 0.72 分。
对于出现功能下降或平台期伴有相关神经症状的颅骨切除术患者，应考虑 SSFS 的诊断。本研究表明，颅骨修补术后 SSFS 患者的 FIM 和 FIM 效率增加，支持及时进行颅骨修补术以改善功能结局并减少康复延迟。
