Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Tissue Expanders in Staged Calvarial Reconstruction: A Systematic Review

  • Andrea Y. Lo (Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of South California) ;
  • Roy P. Yu (Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of South California) ;
  • Anjali C. Raghuram (Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of South California) ;
  • Michael N. Cooper (Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of South California) ;
  • Holly J. Thompson (Wilson Dental Library, Herman Ostrow School of Dentistry of University of South California) ;
  • Charles Y. Liu (Department of Neurological Surgery, Keck School of Medicine of University of South California) ;
  • Alex K. Wong (Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of South California)
  • Received : 2021.07.21
  • Accepted : 2022.03.25
  • Published : 2022.11.15
Download PDF
⟨ Previous Next ⟩

Abstract

Cranioplasties are common procedures in plastic surgery. The use of tissue expansion (TE) in staged cranioplasties is less common. We present two cases of cranioplasties with TE and systematically review literature describing the use of TE in staged cranioplasties and postoperative outcomes. A systematic review was performed by querying multiple databases. Eligible articles include published case series, retrospective reviews, and systematic reviews that described use of TE for staged bony cranioplasty. Data regarding study size, patient demographics, preoperative characteristics, staged procedure characteristics, and postoperative outcomes were collected. Of 755 identified publications, 26 met inclusion criteria. 85 patients underwent a staged cranioplasty with TE. Average defect size was 122 cm2, and 30.9% of patients received a previous reconstruction. Average expansion period was 14.2 weeks. The most common soft tissue closures were performed with skin expansion only (75.3%), free/pedicled flap (20.1%), and skin graft (4.7%). The mean postoperative follow-up time was 23.9 months. Overall infection and local complication rates were 3.53 and 9.41%, respectively. The most common complications were cerebrospinal fluid leak (7.1%), hematoma (7.1%), implant exposure (3.5%), and infection (3.5%). Factors associated with higher complication rates include the following: use of alloplastic calvarial implants and defects of congenital etiology (p = 0.023 and 0.035, respectively). This is the first comprehensive review to describe current practices and outcomes in staged cranioplasty with TE. Adequate soft tissue coverage contributes to successful cranioplasties and TE can play a safe and effective role in selected cases.

Keywords

References

  1. Cho YJ, Kang SH. Review of cranioplasty after decompressive craniectomy. Korean J Neurotrauma 2017;13(01):9-14  https://doi.org/10.13004/kjnt.2017.13.1.9
  2. Erdogan E, Duz B, KocaogluM, Izci Y, Sirin S, Timurkaynak E. The effect of cranioplasty on cerebral hemodynamics: evaluation with transcranial Doppler sonography. Neurol India 2003;51(04):479-481 
  3. Halani SH, Chu JK, Malcolm JG, et al. Effects of cranioplasty on cerebral blood flow following decompressive craniectomy: a systematic review of the literature. Neurosurgery 2017;81(02):204-216  https://doi.org/10.1093/neuros/nyx054
  4. Carvi Y Nievas MN, Hollerhage HG. Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders. Neurol Res 2006;28(02):139-144  https://doi.org/10.1179/016164106X98008
  5. Manders EK, Schenden MJ, Furrey JA, Hetzler PT, Davis TS, Graham WP III. Soft-tissue expansion: concepts and complications. Plast Reconstr Surg 1984;74(04):493-507  https://doi.org/10.1097/00006534-198410000-00007
  6. Baker SR, Swanson NA. Clinical applications of tissue expansion in head and neck surgery. Laryngoscope 1990;100(03):313-319 
  7. Basta MN, Gerety PA, Serletti JM, Kovach SJ, Fischer JP. A systematic review and head-to-head meta-analysis of outcomes following direct-to-implant versus conventional two-stage implant reconstruction. Plast Reconstr Surg 2015;136(06):1135-1144  https://doi.org/10.1097/PRS.0000000000001749
  8. Kirschke J, Georgas D, Sand M, Bechara FG. External tissue expander for closing large defects of the extremities and trunk. J Cutan Med Surg 2013;17(06):423-425  https://doi.org/10.2310/7750.2013.13037
  9. Moher D, Liberati A, Tetzlaff J, Altman DGPRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:b2535 
  10. Akamatsu T, Hanai U, Kobayashi M, et al. Cranial reconstruction in a pediatric patient using a tissue expander and custom-made hydroxyapatite implant. Tokai J Exp Clin Med 2015;40(02):76-80 
  11. Argenta LC. Controlled tissue expansion in reconstructive surgery. Br J Plast Surg 1984;37(04):520-529  https://doi.org/10.1016/0007-1226(84)90143-7
  12. Carloni R, Hersant B, Bosc R, Le Guerinel C, Meningaud JP. Soft tissue expansion and cranioplasty: for which indications? J Craniomaxillofac Surg 2015;43(08):1409-1415  https://doi.org/10.1016/j.jcms.2015.06.017
  13. Carloni R, Herlin C, Chaput B, De Runz A, Watier E, Bertheuil N. Scalp tissue expansion above a custom-made hydroxyapatite cranial implant to correct sequelar alopecia on a transposition flap. World Neurosurg 2016;95:616.e1-616.e5 
  14. Goh KY. Separation surgery for total vertical craniopagus twins. Childs Nerv Syst 2004;20(8-9):567-575 
  15. Lin AY, Kinsella CR Jr, Rottgers SA, et al. Custom porous polyethylene implants for large-scale pediatric skull reconstruction: early outcomes. J Craniofac Surg 2012;23(01):67-70  https://doi.org/10.1097/SCS.0b013e318240c876
  16. Merlino G, Carlucci S. Role of systematic scalp expansion before cranioplasty in patients with craniectomy defects. J Craniomaxillofac Surg 2015;43(08):1416-1421  https://doi.org/10.1016/j.jcms.2015.06.027
  17. Miyazawa T,Azuma R, Nakamura S, Kiyosawa T, Shima K. Usefulness of scalp expansion for cranioplasty in a casewith postinfection large calvarial defect: a case report. Surg Neurol 2007;67(03):291-295  https://doi.org/10.1016/j.surneu.2006.04.019
  18. Origitano TC, Izquierdo R, Scannicchio LB. Reconstructing complex cranial defects with a preformed cranial prosthesis. Skull Base Surg 1995;5(02):109-116  https://doi.org/10.1055/s-2008-1058941
  19. Ozaki M, Narita K, Kurita M, Iwashina Y, Takushima A, Harii K. Implantation of thickened artificial bone for reduction of dead space and prevention of infection between implant and dura in secondary reconstruction of the skull. J Craniofac Surg 2017;28(04):888-891  https://doi.org/10.1097/SCS.0000000000003507
  20. Cascone P, Gennaro P, Ramieri V, Esposito V. Forehead trauma outcomes: restoration of brain, soft tissues, and bone defects: a 3-step treatment. J Craniofac Surg 2009;20(02):498-501  https://doi.org/10.1097/SCS.0b013e31819b9e14
  21. Sari R, Tonge M, Bolukbasi FH, et al. Management of failed cranioplasty. Turk Neurosurg 2017;27(02):201-207 
  22. Tringali G, D'Ammando A, Bono B, Colombetti A, Franzini A. Two-staged frontal bone defect reconstruction: perioperative assessment of scalp vascularization using near-infrared indocyanine green video angiography (Visionsense Iridium). World Neurosurg 2019;126:502-507  https://doi.org/10.1016/j.wneu.2019.02.247
  23. Zhai Z, Yu L, Ren T, Jin X, Yang X, Qi Z. Use of vacuum-assisted wound closure and tissue expansion in revision cranioplasty for a large-sized composite defect in a child. J Craniofac Surg 2019;30(03):838-840  https://doi.org/10.1097/SCS.0000000000005181
  24. Kasper EM, Ridgway EB, Rabie A, Lee BT, Chen C, Lin SJ. Staged scalp soft tissue expansion before delayed allograft cranioplasty: a technical report. Neurosurgery 2012;71(1, suppl operative):15-20 
  25. Komuro Y, Yanai A, Seno H, et al. Surgical treatment of aplasia cutis congenita of the scalp associated with bilateral coronal synostosis. J Craniofac Surg 2002;13(04):513-519  https://doi.org/10.1097/00001665-200207000-00007
  26. Argenta LC, Dingman RO. Total reconstruction of aplasia cutis congenita involving scalp, skull, and dura. Plast Reconstr Surg 1986;77(04):650-653  https://doi.org/10.1097/00006534-198604000-00026
  27. Cho JY, Jang YC, Hur GY, et al. One stage reconstruction of skull exposed by burn injury using a tissue expansion technique. Arch Plast Surg 2012;39(02):118-123  https://doi.org/10.5999/aps.2012.39.2.118
  28. Cienfuegos R, Fernandez G, Cruz A, Sierra E. Cranial bone reconstruction with customized implants after trauma [in Spanish]. Cir Cir 2018;86(03):289-295 
  29. de Moraes SLC, Afonso AMP, Santos RGD, Mattos RP, Duarte EBG. Reconstruction of the cranial vault contour using tissue expander and castor oil prosthesis. Craniomaxillofac Trauma Reconstr 2017;10(03):216-224  https://doi.org/10.1055/s-0036-1584403
  30. Dos Santos Rubio EJ, Bos EM, Dammers R, Koudstaal MJ, Dumans AG. Two-stage cranioplasty: tissue expansion directly over the craniectomy defect prior to cranioplasty. Craniomaxillofac Trauma Reconstr 2016;9(04):355-360  https://doi.org/10.1055/s-0035-1549011
  31. Hadad I, Meara JG, Rogers-Vizena CR. A novel local autologous bone graft donor site after scalp tissue expansion in aplasia cutis congenita. J Craniofac Surg 2016;27(04):904-907  https://doi.org/10.1097/SCS.0000000000002620
  32. Konofaos P, Thompson RH, Wallace RD. Long-term outcomes with porous polyethylene implant reconstruction of large craniofacial defects. Ann Plast Surg 2017;79(05):467-472  https://doi.org/10.1097/SAP.0000000000001135
  33. Mokal NJ, Desai MF. Calvarial reconstruction using high-density porous polyethylene cranial hemispheres. Indian J Plast Surg 2011;44(03):422-431  https://doi.org/10.4103/0970-0358.90812
  34. Mundinger GS, Latham K, Friedrich J, et al. Management of the repeatedly failed cranioplasty following large postdecompressive craniectomy: establishing the efficacy of staged free latissimus dorsi transfer/tissue expansion/custom polyetheretherketone implant reconstruction. J Craniofac Surg 2016;27(08):1971-1977  https://doi.org/10.1097/SCS.0000000000003043
  35. Nakano T, Yoshikawa K, Kunieda T, et al. Treatment for infection of artificial dura mater using free fascia lata. J Craniofac Surg 2014; 25(04):1252-1255  https://doi.org/10.1097/SCS.0000000000000929
  36. Zanaty M, Chalouhi N, Starke RM, et al. Complications following cranioplasty: incidence and predictors in 348 cases. J Neurosurg 2015;123(01):182-188  https://doi.org/10.3171/2014.9.JNS14405
  37. Oliver JD, Banuelos J, Abu-Ghname A, Vyas KS, Sharaf B. Alloplastic cranioplasty reconstruction: a systematic review comparing outcomes with titanium mesh, polymethyl methacrylate, polyether ether ketone, and norian implants in 3591 adult patients. Ann Plast Surg 2019;82(5S, suppl 4):S289-S294  https://doi.org/10.1097/SAP.0000000000001801
  38. Onishi K, Maruyama Y, Seiki Y. Intra-operative scalp expansion for wound closure without tension in craniosynostosis operation- technical innovation. J Craniomaxillofac Surg 1995;23(05):317-320  https://doi.org/10.1016/S1010-5182(05)80163-5
  39. Nichols DD, Bottini AG. Aplasia cutis congenita. Case report. J Neurosurg 1996;85(01):170-173 https://doi.org/10.3171/jns.1996.85.1.0170