Is polymethylmethacrylate reliable and practical in full-thickness cranial defect reconstructions?

OBJECTIVE: The study aimed to evaluate the success of polymethylmethacrylate cranioplasty combined with various soft tissue coverage techniques in repairing full-thickness cranial defects, to compare our results with similar studies published before, and to describe a simple method of implant premolding. METHODS: A total of 17 patients who had cranial defects due to various etiologies underwent polymethylmethacrylate cranioplasty. In 10 patients, the implant premolding method was applied. The soft tissue coverage was obtained by primary closure, local flaps, or free flaps. RESULTS: The follow-up period ranged from 36 hours to 5 years. Only 1 implant became exposed among the 17 patients. One patient died 36 hours after the surgery because of myocardial infarction. The remaining 15 patients had no early or late postoperative complications. Good contour restoration and stable reconstruction of the calvarial defects were realized, and a successful combination of various soft tissue coverage techniques was achieved. CONCLUSIONS: We concluded that polymethylmethacrylate was a cheap and durable material, useful in full-thickness calvarial defect reconstructions. It can be combined with any soft tissue coverage techniques except skin grafting. In most cases, the simple premolding methods are useful for both defect matching and preventing tissue damage due to exothermic reaction of the material.

Salvage of suboptimal results in a reconstructed ear: nonsurgical reshaping with triamcinolone.

BACKGROUND: Ear reconstruction with autologous tissues and creating a natural-appearing ear is a difficult, multistage surgical procedure. Problems, such as a thick skin or an inadequate cartilage-flap relationship, may cause obliteration of the framework details. A nonsurgical technique to improve auricular definition is described. MATERIALS AND METHODS: Twenty-six patients with reconstructed ears due to inadequate auricular definition were enrolled in the study. To achieve a better auricular shape, triamcinolone acetonide injections up to 4 sessions were applied. Results of injections were evaluated by improvement of ear contours, quality of detail, frequency of injections, and complications. In addition, histopathologic studies were carried out in 8 patients. RESULTS: The results were satisfactory. Significant recovery was observed in auricular definition in all patients. There were no major complications observed as a result of the use of steroids during the long follow-up period, suggesting that our technique was safe. CONCLUSIONS: The solution to unfavorable results of a primary auricular reconstruction generally requires extremely difficult and challenging procedures. In selected patients, triamcinolone injections may be a remedy and may be helpful in avoiding complex surgical procedures.