Intracranial Microvascular Free Flaps

ABSTRACT

Large acquired intracranial defects can result from trauma or surgery. When reoperation is required because of infection or tumor recurrence, management of the intracranial dead space can be challenging. By providing well-vascularized bulky tissue, intracranial microvascular free flaps offer potential solutions to these life-threatening complications. A multi-institutional retrospective chart and radiographic review was performed of all patients who underwent microvascular free-flap surgery for salvage treatment of postoperative intracranial infections between 1998 and 2006. A total of six patients were identified with large intracranial defects and postoperative intracranial infections. Four patients had parenchymal resections for tumor or seizure and two patients had posttraumatic encephalomalacia. All patients underwent operative debridement and intracranial free-flap reconstruction using the latissimus dorsi muscle (n = 2), rectus abdominis muscle (n = 2), or omentum (n = 2). All patients had titanium (n = 4) or Medpor (n = 2) cranioplasties. We concluded that surgery or trauma can result in significant intracranial dead space. Treatment of postoperative intracranial infection can be challenging. Vascularized free tissue transfer not only fills the void, but also provides a delivery system for immune cells, antibodies, and systemically administered antibiotics. The early use of this technique when intracranial dead space and infection coexist is beneficial.

Microvascular free flap - intracranial - infection - reconstruction - salvage

REFERENCES

• 1 White R J, Schreiner L H, Hughes R A, MacCarty C S, Grindlay J H. Physiologic consequences of total hemispherectomy in the monkey; operative method and functional recovery.  Neurology. 1959;  9 149-159
• 2 Rasmussen T. Hemispherectomy for seizures revisited.  Can J Neurol Sci. 1983;  10 71-78
• 3 Matheson J M, Truskett P, Davies M A et al.. Hemispherectomy: a further modification using omentum vascularized free flaps.  Aust N Z J Surg. 1993;  63 646-650
• 4 Sugawara Y, Harrii K, Yamada A et al.. Reconstruction of skull defects with vascularized omentum transfer and split calvarial bone graft: two case reports.  J Reconstr Microsurg. 1998;  14 101-108
• 5 Schwabegger A H, Rainer C, Laimer I et al.. Hemispheric brain volume replacement with free latissimus dorsi flap as first step in skull reconstruction.  Microsurgery. 2005;  25 325-328
• 6 Mathes S, Nahai F. Reconstructive Surgery: Principles, Anatomy, & Technique. St. Louis, MO; Churchill Livingstone/Quality Medical Publishing 1997: 1-433
• 7 O'Malley Jr B W, Janecka I P. Evolution of outcomes in cranial base surgery.  Semin Surg Oncol. 1995;  11 221-227
• 8 Anthony J P, Mathes S J, Alpert B S. The muscle flap in the treatment of chronic lower extremity osteomyelitis: results in patients over 5 years after treatment.  Plast Reconstr Surg. 1991;  88 311-318
• 9 Salgado C J, Mardini S, Jamali A A et al.. Muscle versus nonmuscle flaps in the reconstruction of chronic osteomyelitis defects.  Plast Reconstr Surg. 2006;  118 1401-1411
• 10 Yazar S, Lin C H, Lin Y T et al.. Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle traumatic open tibial fractures.  Plast Reconstr Surg. 2006;  117 2468-2475
• 11 Schmidek A K, Warren S M, Tantillo M B et al.. Salvage treatment of an irradiated, infected lumbosacral wound.  Ann Plast Surg. 2005;  55 531-534
• 12 Shen Y M, Shen Z Y. Greater omentum in reconstruction of refractory wounds.  Chin J Traumatol. 2003;  6 81-85