Sharaf, Basel

Decompressive craniectomy is a life-saving procedure performed to treat intracranial hypertension caused by a variety of conditions. Subsequent cranioplasty reconstruction is needed for brain protection. Different alloplastic materials with different advantages and disadvantages are available for cranial reconstruction. We present the first case of a deformed titanium cranioplasty mesh in a paediatric patient following head trauma. Children who have undergone cranioplasty reconstruction should be counselled to wear a protective helmet when involved in contact sports or activities that may put their implant at risk of trauma.

Background: Two-staged implant-based reconstruction (IBR) is the most common breast reconstructive modality. Recently, technological and surgical advances have encouraged surgeons to revisit prepectoral IBR. Data comparing prepectoral against subpectoral IBR in women under the age of 40 are lacking. Methods: Retrospective chart review of patients under the age of 40 years old, who underwent immediate 2-staged IBR at our institution, was performed. Patient’s demographics, clinical characteristics, operative details, and early surgical outcomes of prepectoral and subpectoral reconstruction were compared. Data with values of P < 0.05 were considered statistically significant. Results: Between 2012 and 2016, 100 patients (187 breasts) who underwent prepectoral and 69 patients (124 breasts) who underwent subpectoral IBR were included. Median follow-up was 17.9 and 17.5 months in the prepectoral and subpectoral groups, respectively. Total number of complications including both stages of reconstruction was 20 (10.7%) and 19 (15.3%) in the prepectoral and subpectoral groups, respectively (P = 0.227). Specific complications, including hematoma, seroma, skin flap necrosis, wound dehiscence, and breast infections, were not significantly different among groups. Ten (5.4%) devices, including implants and tissue expander, required explantation in the prepectoral group and 8 (6.5%) in the subpectoral group (P = 0.683). Explantation was most commonly due to infection (n = 14), and all of them occurred during the first stage (P < 0.001). Conclusions: Early complications and implant explantation rates are comparable among prepectoral and subpectoral breast reconstruction in women under 40 years old. Based on these results, we believe that prepectoral IBR is a safe, reliable, and promising reconstructive option.

Abstract An 8-year-old boy with oculo-auriculo-vertebral syndrome presented to the authors’ clinic for multidisciplinary management of his condition. His congenital ear deformity included bilateral protrusion as well as atypical Microtia affecting the left side. He underwent bilateral otoplasty combined with left canaloplasty at the first stage to address prominent ears and canal atresia and. The patient underwent subsequent reconstruction of his constricted left ear with costochondral cartilage graft to address elsewhere. He presented to the authors’ clinic 2 weeks postoperatively with wound dehiscence and cartilage exposure along the scapha surface. The authors present their management strategy utilizing a preauricular pedicled perforator cutaneous flap in a staged manner with emphasis on technical details and review of available flap options for management of such complications.

Background Acquired defects of the cranium represent a reconstructive challenge in patients with calvarial bone loss due to trauma, infection, neoplasia, congenital malformations, or other etiologies. The objective of this study was to compare postoperative rates of infection, local complications, and allograft failures following cranioplasty reconstruction using titanium mesh (Ti), polymethyl methacrylate (PMMA), polyether ether ketone (PEEK), and Norian implants in adult patients. Methods This constitutes the first systematic review of available literature on 4 different methods of alloplastic cranioplasty reconstruction, including Ti, PMMA, PEEK, and Norian implants, using the Newcastle-Ottawa Quality Assessment Scale guidelines for article identification, screening, eligibility, and inclusion. Electronic literature search included Ovid MEDLINE/PubMed, EMBASE, Scopus, Google Scholar, and Cochrane Database. Pearson exact test was utilized at P < 0.05 level of significance (J.M.P. v11 Statistical Software). Results A total of 53 studies and 3591 patients (mean age, 40.1 years) were included (Ti = 1429, PMMA = 1459, PEEK = 221, Norian = 482). Polymethyl methacrylate implants were associated with a significantly higher infection rate (7.95%, P = 0.0266) compared with all other implant types (6.05%). Polyether ether ketone implants were associated with a significantly higher local complication rate (17.19%, P = 0.0307, compared with 12.23% in all others) and the highest ultimate graft failure rate (8.60%, P = 0.0450) compared with all other implant types (5.52%). Conclusions This study qualifies as a preliminary analysis addressing the knowledge gap in rates of infection, local surgical complication, and graft failure in alloplastic cranioplasty reconstruction with different implant types in the adult population. Longer-term randomized trials are warranted to validate associations found in this study.

Background Patients diagnosed with end-stage renal disease (ESRD) are increasing at around 5% annually. Some of these patients will require free tissue transfers to reconstruct their body after trauma or cancer resection. Comorbidities can increase the level of complexity during reconstruction. Aim Our goal is to describe the outcomes of ESRD patients under dialysis who underwent free tissue transfer for head and neck reconstruction. Methods Two cohorts were analyzed: ESRD group on dialysis and a non-ESRD control group after free tissue transfer for head and neck reconstruction. Postoperative complications and mortality were recorded. For coexisting comorbidities, we determine the presence of diabetes mellitus (DM) and peripheral vascular disease (PVD). Results In this study, 85 cases with ESRD on dialysis and 841 controls were analyzed. Most patients were aged ≤ 65 years (82.5%) and nearly 92.9% of them were men. Types of head and neck cancer were neoplasm of other and unspecified parts of the mouth followed by neoplasm of tongue, the gingiva, hypopharynx, and floor of mouth. Patients with ESRD tended to have higher rates of DM and PVD (p < 0.001) and were significantly associated with an increased risk of stroke and increased risk of 30-day mortality. However, there was no significant difference regarding flap failure among groups. Conclusion Despite greater preoperative risk factors, patients with renal failure on hemodialysis do not appear to have a higher rate of free flap failure following head and neck reconstruction. However, other complications can be minimized by optimizing patient's medical condition to succeed with this reconstructive effort.

Helmet wear offers protection in various ways against craniomaxillofacial and brain trauma. The specific pattern and overall burden of craniofacial trauma among helmeted and unhelmeted patients has not been well defined. This is a retrospective review of trauma patients involved in documented helmet-associated injuries that presented to the Mayo Clinic Emergency Department in Rochester, Minnesota, and completed initial trauma evaluation between 1999 and 2015. A total of 417 patients (50% unhelmeted, 82% male) were identified. The median age at injury was 22.9 years (interquartile range [IQR]: 15.2–44.2]) and median follow-up was 26 months ([IQR: 2.2–64.8]). The majority of injuries involved motorcycle accidents (57.6%), bicycles (30.2%), and other modes of injury (12.7%). The mean Glasgow Coma Score (GSC) at the time of presentation was 14.2 (SD ± 2.4) and mean injury severity score (ISS) was 10.2 (SD ± 7.5). Motorcycle accidents had a higher mean ISS compared with other modes of injury ( p = 0.048). Unhelmeted patients were more likely to sustain scalp lacerations ( p < 0.0001), facial bone fractures ( p = 0.01), scalp hematomas ( p = 0.041), skull fractures ( p = 0.017), and are more likely to require hospital admission ( p = 0.0003). Unhelmeted patients’ hospital length of stay was on average 2 days longer than helmeted patients’ stay ( p = 0.0721). Unhelmeted patients were more likely to require out-of-home placement than helmeted patients. Among trauma patients, helmet use was associated with less scalp lacerations and hematomas, facial bones fractures, skull fractures, and need for hospital admission. Adoption of legislation and regulations mandating protective helmet use in all states are strongly encouraged to minimize the burden of craniofacial injuries among unhelmeted patients.