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Subtotal calvarial vault reconstruction utilizing a customized polyetheretherketone (PEEK) implant with chimeric microvascular soft tissue coverage in a patient with syndrome of the trephined: A case report
Archives of Plastic Surgery ; : 365-370, 2019.
Article in English | WPRIM | ID: wpr-762841
ABSTRACT
The syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed—correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.
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Full text: Available Index: WPRIM (Western Pacific) Main subject: Postoperative Period / Follow-Up Studies / Cognition / Plastic Surgery Procedures / Debridement / Free Tissue Flaps / Myocutaneous Flap / Craniocerebral Trauma / Hemodynamics / Metabolism Type of study: Observational study / Prognostic study Limits: Humans / Male Language: English Journal: Archives of Plastic Surgery Year: 2019 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Postoperative Period / Follow-Up Studies / Cognition / Plastic Surgery Procedures / Debridement / Free Tissue Flaps / Myocutaneous Flap / Craniocerebral Trauma / Hemodynamics / Metabolism Type of study: Observational study / Prognostic study Limits: Humans / Male Language: English Journal: Archives of Plastic Surgery Year: 2019 Type: Article