Orozco-Villaseñor H,Aguirre-Jáuregui Ó, González-García I, Guzmán-Montes de Oca R, Zúñiga-Gordillo R, Monroy-Marín Y, Erro-Aboytia R

Language: Spanish
References: 11
Page: 78-84
PDF size: 686.64 Kb.

ABSTRACT

Introduction: Cranial defects can occur after suffering head trauma or as a consequence of neurosurgery, they can compromise scalp and bone, and are associated with a greater incidence of infection and cerebrospinal fluid fistula. When these cranial defects occur in pediatric patients, the reconstructive technique can become quite a challenge to the plastic surgeon because: 1) the head keeps a greater proportion compared to the rest of the body as it does in adults, which can make obtaining donating sites much more difficult. 2) In those cases in which it is necessary to perform microvascular tissue transplant, donating vascular caliber can be greater than receiving vascular caliber, making microvascular anastomosis difficult.
Objective: To present the experience of the Pediatrics Plastic Surgery and Microsurgery clinics in reconstruction of complex cranial defects in pediatric patients.
Materials and Methods: A prospective study was designed, which included all patients 15 years old and younger with complex cranial defects that involve scalp, bone or both. Demographic and defect characteristic's data was gathered as well as the reconstructive strategy, type of flap, outcome of the surgery and functional status obtained.
Results: A total of five patients were included between June the 1st and October the 1st 2012, three male and two female. Average age was 6.2 years. Average failed reconstruction intents were 2.2 (2 – 7). Cranial defects involved skin and bone in four patients, and skin only in one patient. Causes of cranial defects were brain tumor in one patient, head trauma in two, and fungus infection in one patient. Reconstructive strategies included: 1) Local rotation flaps, 2) Island trapezius flap, 3) Superficial forehead temporoparietal fascia flap interposition, 4) Latissimus dorsi free flap and, 5) Anterolateral thigh free flap. In all patients skull defects were corrected successfully and a cerebrospinal fluid fistula was corrected in one patient.
Discussion: Most published patient series concerning reconstruction of cranial defects include only adults, very few review the procedures performed in pediatric patients. With the development of better microdissection and microanastomosis techniques, free tissue transfer will be the best reconstructive option for small children.

REFERENCES

1. Lee S, Rafii AA, Sykes J. Advances in Scalp Reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2006; 14(4):249-53.

2. Chang KP, Lai CH, Chang CH, Lin CL, Lai CS, Lin SD. Free flap options for reconstruction of complicated scalp and calvarial defects: report of a series of cases and literature review. Microsurgery. 2010; 30(1):13-8.

3. Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plast Reconstr Surg. 2005; 15; 116(4):54e-72e.

4. Hierner R, van Loon J, Goffin J, van Calenbergh F. Free latissimus dorsi flap transfer for subtotal scalp and cranium defect reconstruction: report of 7 cases. Microsurgery. 2007; 27(5):425-8.

5. Mikami T, Minamida Y, Sugino T, Koyanagi I, Yotsuyanagi T, Houkin K. Free flap transfer for the treatment of intractable postcraniotomy subdural empyemas and epidural abscesses. Neurosurgery 2007; 60(2 Suppl 1):ONS83-7

6. Wang HT, Erdmann D, Olbrich KC, et al. Free flap reconstruction of the scalp and calvaria of major neurosurgical resections in cancer patients: lessons learned closing large, difficult wounds of the dura and skull. Plast Reconstr Surg. 2007; 119(3):865-72.

7. 7.Melek RK. Surgical Flaps. Selected Readings in Plastic Surgery, 1999; 9(2):1 2.

8. 8.Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987; 40(2):113- 41.

9. Blondeel PN, Van Landuyt KH, Monstrey SJ, Matton GE, Allen RJ, et al. The "Gent" consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg. 2003; 112(5):1378-83.

10. 10.Morris SF, Tang M, Almutari K, Geddes C, Yang D. The anatomic basis of perforator flaps. Clin Plast Surg. 2010; 37(4):553-70, xi.

11. 11.St-Hilaire H, Mithani SK, Taylor J, et al. Restoring the failed cranioplasty: nonanatomical titanium mesh with perforator flap. Plast Reconstr Surg. 2009; 123(6):1813-7.