반복적인 두개내 감염에서 유리 대망피판을 이용한 경질막 재건

Dural Reconstruction in Refractory Cranial Infection using Omental Free Flap

  • 유지한 (서울대학교 의과대학 성형외과학 교실) ;
  • 은석찬 (서울대학교 의과대학 성형외과학 교실) ;
  • 한정호 (서울대학교 의과대학 신경외과학 교실) ;
  • 백롱민 (서울대학교 의과대학 성형외과학 교실)
  • Yoo, Ji Han (Department of Plastic and Reconstructive Surgery, College of Medicine Seoul National University) ;
  • Eun, Seok Chan (Department of Plastic and Reconstructive Surgery, College of Medicine Seoul National University) ;
  • Han, Jung Ho (Department of Plastic and Reconstructive Surgery, College of Medicine Seoul National University) ;
  • Baek, Rong Min (Department of Plastic and Reconstructive Surgery, College of Medicine Seoul National University)
  • 발행 : 2009.09.15

초록

Purpose: Epidural abscesses and subdural empyemas after craniotomy are uncommon, potentially lethal, complications of neurosurgery. Patients with these complications may be difficult to manage and dural reconstruction in these patients are challenging. Methods: A 28 - year - old female patient showed recurrent intracranial infection after craniotomy for evacuation of a arachnoid cyst and subdural hematoma. Despite prolonged systemic antibiotic administration and a debridement of the subdural space, infection persisted, as evidenced by persistent fever, an elevated WBC count, CSF leakage, low CSF glucose level, and purulent wound discharge. The authors removed the previously applied lyophilized dura and transferred free omental flap to reconstruct the dura, obliterate the cyst and cover the cerebral hemisphere in the craniotomy defect. Microvascular anastomosis was between gastroepiploic and superficial temporal vessels. Results: The postoperative course was uneventful and flap survival was excellent. The infection - resistant omental tissue allowed sufficient blood circulation and dead space control. The patient was discharged 1 month after surgery and wound discharge or recurrence was absent during 13 months of follow up periods. Conclusion: The use of vascularized free omentum proved useful in cases of intractable cranial wound infection and cerebrospinal fluid leakages.

키워드

참고문헌

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