Successful Treatment of Full Thickness Frontal Skull Bone Defect With Dermal Fat Grafting and Artificial Bone Grafts.

Rigid reconstruction for frontal bone defects not only improves function, but also approximates more normal appearance. However, in cases involving dural scar contractures, a concave deformation remains when rigid reconstruction is performed without compensating for dead space created by swelling of the brain. This study involved 4 cases in which a 2-stage reconstruction procedure was used to first eliminate dead space by grafting dermal fat, and subsequently carry out rigid reconstruction to achieve a natural forehead configuration. This method is advantageous and considered to be effective in allowing dead space to be easily filled with minimal invasiveness for concave deformations of the dura mater with bone defects. Furthermore, the risk of artificial bone exposure is reduced by adding the dermal component of dermal fat, which is grafted to thinned frontal skin.

Surgical Management of Deep Brain Stimulator Infection without Electrode Removal: Report of Two Cases.

Objective Stimulation of the subthalamic nucleus by implanted electrodes (deep brain stimulation [DBS]) is performed to suppress symptoms of Parkinson's disease. However, postoperative wound dehiscence and infection can require removal of the implanted electrode leads. This report describes treatment of intractable unilateral wound infection in two patients without removing the DBS device. Methods First, components of the DBS system were removed except for the electrode lead and thorough debridement of the infected wound was conducted. Second, the edges of the bone defect left by removal of DBS components were smoothed to eliminate dead space. Subsequently, the electrode lead was covered by using a pericranial-frontalis-muscle flap or a bi-pedicled-scalp flap with good blood supply. Closed intrawound continuous negative pressure and irrigation treatment was conducted for 1 week after the surgery, and then the drain was removed. Results We treated two patients with wound infection after implantation of DBS electrodes. Case 1 developed a cutaneous fistula and Case 2 had wound dehiscence. After treatment by the method described above, complete wound healing was achieved in both patients. Conclusion DBS is always associated with a risk of infection or exposure of components and treatment can be very difficult. We successfully managed intractable wound infection while leaving the electrode lead in situ, so that it was subsequently possible to continue DBS for Parkinson's disease.

Late-Onset Infection of Resorbable Plates After Multiple Facial Fractures.

In recent years, a variety of resorbable plates have been used for craniofacial fractures. The authors report a case of plate infection that occurred more than 1 year after surgery and was difficult to distinguish from a foreign body reaction. A 19-year-old male suffered fractures of the right zygomatic bone, orbital floor, and left maxilla in a motorcycle accident. Reduction was performed using resorbable plates at 7 days after injury. The postoperative course was good. However, the patient presented 396 days after surgery with redness/swelling of the right upper eyelid and right cheek pain. There were no systemic signs of infection such as fever. A foreign body reaction to the plate was suspected. After 1 week, swelling of the patient's upper eyelid was worse, and the remaining resorbable plate was removed via a skin incision. Swelling subsequently extended to the right cheek and upper gingiva, and all plates were removed under general anesthesia on the 418th day after the first operation. The swelling subsided after removal of the plates. Pathological examination revealed neutrophil infiltration and Staphylococcus hominis was detected by bacterial culture, leading to a diagnosis of late-onset plate infection. This coagulase-negative staphylococcus usually causes infection in neonates and immunocompromised individuals. Postoperative complications of resorbable plates include foreign body reaction and infection, which are difficult to differentiate clinically. Removing the foreign body is the principal technique for obvious wound infection. A foreign body reaction with subcutaneous fluid retention is slow to heal. Therefore, early plate removal is also recommended.