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Purse-String Closure for Frontoethmoidal Encephalomeningocele

Aojanepong, Chongdee MD

Journal of Craniofacial Surgery:
doi: 10.1097/SCS.0b013e31822e5dc5
Original Articles

Background: Skin incision over the nose is routinely made for accessing the nasal structures, removing the mass, as well as resecting the redundant skin in patients with frontoethmoidal encephalomeningocele (FEEM). Unfortunately, the conventional elliptical excision leaves a long, straight-line scar that becomes a stigma of the disease.

Objective: The author describes a purse-string closure technique for closure of the skin defect over the nasal dorsum in a patient with FEEM, which results in the reduction of a surgical scar.

Methods: The skin overlying the encephalocele is pinched and marked around the mass. The skin is cut, and the encephalocele is dissected deep down the bony opening. Then a bicoronal scalp flap and frontal craniotomy and bilateral medial orbital walls osteotomies are performed. The encephalocele is removed at the neck, and the dural defect is repaired. The bony defect is repaired and bone-grafted as necessary. The skin defect is closed with double layers with the purse-string closure technique and crisscross mattress sutures.

Results: Between January 2004 and July 2009, a total of 7 FEEM patients underwent a 1-stage combined intracranial and extracranial repair and reconstruction of the deformity using the purse-string closure technique.

Conclusions: The purse-string closure technique as described provides an alternative skin closure for the repair and reconstruction of FEEM.

Author Information

From the Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Received November 24, 2010.

Accepted for publication January 30, 2011.

Address correspondence and reprint requests to Chongdee Aojanepong, MD, Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkoknoi, Bangkok, 10700, Thailand; E-mail:

The author reports no conflicts of interest.

© 2011 Mutaz B. Habal, MD