cranioplasty

In the open brain injury, especially after the firearm injury, due to the need of debridement, there are often different ranges of skull defects. In closed injuries, it is often necessary to perform decompression of the bone flap due to severe brain swelling. A large skull defect was left after surgery. For bone defects with a diameter of less than 3 cm, there is often no discomfort. Generally, no angioplasty is required, and those with a diameter of more than 3 cm should be subjected to cranioplasty. The purpose of cranioplasty: 1 to avoid re-injury of the brain. 2 treatment of skull defect syndrome. 3 for shaping. In the repair materials, the ribs, tibia or allogeneic bones that have been used in the past have been used sparingly. Titanium alloy sheets and plexiglass are currently more commonly used. The skull removed during the operation is temporarily buried under the skin and retained in the patient's own body. When the surgery is performed, it is removed and placed in the skull defect area. Some people also use polymer fiber reinforced materials, which are suitable for the skull, such as toughness, hardness and flexibility. It has good biocompatibility, stable chemical properties, no toxicity, no antigen-antibody reaction. After repairing, there is no burning sensation, no radiation chronic brain damage, and it has the advantages of light weight, easy cutting and shaping. In addition to the one-stage surgical procedure, the forming surgery should be performed in the first 3 to 6 months after the first operation. Those with traumatic infections need to be healed after 1 year of wound healing. Treatment of diseases: craniocerebral injury, open brain injury Indication 1. The diameter of the bone defect is more than 3cm, so that the protection of the brain is affected. 2. There are serious symptoms. Such as dizziness, headache, and symptoms worsen when the head position changes. 3. Have a serious mental burden, such as fear of sound, fear of vibration, fear of trauma. 4. Large bone defects impede the appearance. 5. Patients with epilepsy in the defect area. Contraindications 1. Infection at the wound site, or infection has been healed but less than 1 year. 2. There is still an increase in intracranial pressure. 3. Debridement is not thorough enough, and there are broken bone fragments. 4. People with severe neurological dysfunction or mental disorders. Preoperative preparation In addition to the routine craniotomy preparation, a hole should be made every 2cm when preparing the graft, so that the scalp and the meninges will form adhesions, which will help the fixation of the graft. Surgical procedure 1. A horseshoe-shaped incision along the edge of the defect. The blood supply to the flap should be fully considered when designing the flap. 2. Separate from the aponeurotic aponeurosis, and then retract the incision with an automatic retractor after flipping the flap. 3. On the edge of the bone defect, the dura mater is peeled off to reveal the edge of the bone defect. 4. Trim the nucleus of the irregular bone defect with a rongeur. The bone edge is neat and sloped so that the formed graft does not collapse after implantation. 5. Place the prepared graft piece in the defect, and cut the piece according to the size and shape of the defect, so that the shape of the piece is suitable for the convexity of the skull. It is very stable after being placed in the defect and is not easy to move. 6. Fix the graft and fix the implant with the skull at 4 points. Use a Kirschner wire to drill holes in the corresponding skull. Do not hold the hole close to the bone edge. Fix the thick wire or stainless steel wire. If the skull defect is large, the dura mater in the center of the defect should be suspended on the graft with a silk thread to reduce the dead space and prevent postoperative hematoma and effusion. 7. Finally suture the scalp. The scalp is placed under the drain. complication 1. After the operation, the effusion under the graft can be self-healing after being attracted by puncture. 2. Dura mater hematoma due to adhesions in the scars of new capillaries, after the separation is prone to extensive bleeding of the wound, before suturing the incision, should completely stop bleeding.