• Archives of Plastic Surgery
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• v.32 no.6
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• pp.744-752
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• 2005

Many craniofacial and neurosurgical procedures rely on cranial bone as a bone graft. In the majority of instances, the bone heals and gives good results. But we found that if either the dura or the pericranium were missing adjacent to the cranial bone, bone absorption would be increased. We studied a single animal model, investigating the contribution of the dura and the pericranium in the process of cranial bone absorption. The animals were divided into four groups of each five animals depending on the differential blockade of the dura and/or the pericranium by silastic sheet. Bilateral $100-mm^2$, parietal bone flaps were harvested from mature rabbits. Animals were humanely killed after 12 weeks, and histomorphometric analysis was performed. The volume maintenance is as follows; Group I; 89.0%, Group II; 80.0%, Group III; 63.3%, Group IV; 52.4%. The weight maintenance; Group I; 87.1%, Group II; 79.4%, Group III; 61.6%, Group IV; 51.1%. The histological contribution of living bone; Group I; 92.9%, Group II; 85.6%, Group III; 71.1%, Group IV; 56.2%. Significantly increased bone absorption occurred in Group II, III, IV compared with Group I. Conclusions are: 1. Cranial bone absorption is effected by both the dura and the pericranium. 2. The dura is more important than the pericranium in preventing cranial bone absorption. 3. The dura to be the source of central cranial bone and the pericranium to be the source of peripheral cranial bone.

• Archives of Plastic Surgery
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• v.32 no.2
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• pp.189-193
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• 2005

Reconstruction of calvarial bone defects from congenital anomaly or from bone loss due to traumatic or neoplastic processes remains a significant problem in craniofacial surgery and neurosurgery. To facilitate bone regeneration, there have been many trials such as autologous bone graft or allograft, and the addition of demineralized bone matrix and matrix-derived growth factor. Guided bone regeneration is one of the methods to accelerate bone healing for calvarial bone defects especially in children. Pericranium is one of the most usable structure in bone regeneration. It protects the dura and sinus, and provides mechanical connection between bone fragments. It supplies blood to bone cortex and osteoprogenitor cells and enhances bone regeneration. For maximal effect of pericranium in bone regeneration, authors used pericranium as a flap for covering calvarial defects in surgeries of 11 craniosynostosis patients and achieved satisfactory results: The bone regeneration of original cranial defect in one year after operation was 74.6%(${\pm}8.5%$). This pericranial flap would be made more effectively by individual dissection after subgaleal dissection rather than subperiosteal dissection. In this article, we reviewed the role of pericranium and reported its usefulness as a flap in surgery of craniosynostosis to maximize bone regeneration.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1519-1522
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• 2000

Sugaleal hematoma usually develop one to eight days after minor head trauma or clotting disorders in children. The galeal aponeurosa in children is loosely attatched to the pericranium, allowing the collection of large quantity of blood. Most cases of subgaleal hematomas resolve spontaneously, however some cases require surgical intervention, aspiration of subgaleal hematoma often alleviate symptoms briefly and but do not shorten the time to resolution. Reaccumulation, infection following aspiration also had been reported. Here, we report the efficacy of using the blood donating set for the treatment of subgaleal hematoma in our series.

• Journal of Yeungnam Medical Science
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• v.9 no.2
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• pp.422-426
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• 1992

One case of Congenital Cutis Aplasia is presented. The defect involved includes full-thickness skin defect of scalp and cranium. The patient was treated with debridement of dirty necrosed crust which covered exposed dura mater and with double opposing rotation flap including pericranium for bone regneration. The donor site was covered with skin graft from right thigh. During operation, the superficial temporal arterty was found to be short and weak. And after operation, the margin of flap were congested and finally necrotized. The necrotic wound was treated with conservative management. The vascular impairment is thought to be main course of Congenital Cutis Aplasia. So we conclude that the treatment of choice is conservative management or careful flap surgery for coverage of defect area.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.491-494
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• 2006

Purpose: To report the case of recurred malignant proliferating trichilemmal tumor on scalp Methods: Case report and literature review Results: A 40-year-old man presented with a recurred malignant proliferating trichilemmal tumor, which developed on the occipital area. It was $8{\times}9{\times}4.5cm$ in size, protruded, firm and non-tender mass. This tumor was widely excised including normal skin margin and pericranium. Immediate reconstruction using free latissimus dorsi muscle flap and skin graft were done. Histopathologic examination revealed abrubt, compact trichilemmal keratinization in the central area of lobular epithelial proliferation. Conclusion: There has been no recurrence of tumor during follow-up period of nine months without adjuvant chemotherapy or radiotherapy.

• Journal of Korean Neurosurgical Society
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• v.29 no.5
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• pp.668-674
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• 2000

Objective : The classic and accepted surgical method of compound comminuted depressed skull fractures (FCCD) involves total resection of all the contaminated bone and fragments at the fracture site. A second operation for cranioplasty is then performed at a later date. However, we have believed that primary repair of these bony defects can be achieved by the replacement of bone fragments at the time of the initial debridement, and this can be accomplished without danger to patient. The authors retrospectively reviewed the surgical results to assess the advantages and disadvantages, and also propose the selection criteria of replacement of fractured bone fragments as a primary procedure in FCCD. Materials and Methods : The authors analyzed the data extracted from medical records, and radiological findings in 22 of 71 patients with FCCD, who underwent immediate replacement of fractured bone fragments between April 1993 and October 1998. The mean follow-up period was 13.7 months. The selection criteria for the operation included the patients with mild to moderate severity, regardless of the degree of contamination or dural violation, which presented in hospital within 24 hours of injury. Results : The ages of the patients varied from 4 to 63 years, and there were 20 males and 2 females. Seventeen of 22 patients were fully conscious on admission and the others also had relatively good Glasgow coma scales. Sixteen fractures were located in the frontal area, 9 with involvement of the frontal sinuses, and 6 in the parietal and temporoparietal areas. Of the 22 patients, 8(36.3%) had dural lacerations with 3 of these requiring patching with pericranium, and 12(54.5%) had intracranial hematoma requiring wide craniotomy. The degree of wound contamination was also variable. Fifteen patients had relatively clean wounds, while seven(31.8%) had seriously contaminated wounds with soil, sand, hair, and wood. Only one patient(4.5%) developed infection, and the bone fragments were removed. All wounds healed primarily without pulsatile defect, the skull has remained solid, and no complications have occurred, except the infected case. Conclusion : It is proposed that bone fragments removal for FCCD, regardless of the degree of contamination or dural violation, is not necessary and that primary bone fragments replacement avoids a second operation for cranioplasty.

• Journal of Trauma and Injury
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• v.20 no.1
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• pp.52-56
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• 2007

Marjolin's ulcer is a rare and often-aggressive cutaneous malignancy that arises in previously traumatized or chronically inflamed skin, particularly after burns. We experienced two cases after burns. Case I involved a forty eight year-old man who had suffered from a flame burn at the parietal scalp area, where had been initially described three years earlier as a full-thickness wound including the pericranium. The man consulted us for a persistent ulcerative and infected wound on the burned lesion during the last 24 months, which turned out on the contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) to be the squamous cell carcinoma with involving the skull and the dura mater. Although the posterior auricular lymph node was enlarged on the ipsilateral side, recent positron emission tomography (PET) CT did not show any metastatic lesion. It was impossible for us to resect the intracranial involvement of the tumor radically, and the postoperative PET CT still showed a focal fluorodeoxyglucose (FDG) uptake around the wall of the superior sagittal sinus. We think that an aggressive combined approach is essential for treatment in early stages for a high success rate, before the intracranial structures are involved because there is no consensus on the treatment for advanced disease, and the results are generally poor. Case 1 also did not involve a radical resection because of the intracranial invasion to the wall of superior sagittal sinus and the possibility of damage to the major cortical veins. He received adjuvant radiotherapy and must be followed periodically. Case 2 involved an eighty six year-old women who suffered from a painful scalp ulcer lesion after flame burns three years earlier. Unlike case 1, neither tumor infiltration into the dura nor lymph node enlargement was observed on the contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) CT. We did a radical resection of the tumor, including the involved bone, and a cranioplasty with bone cement.