The purpose of this study was to review our experience in single-stage reconstruction
of skull and scalp defects
, aiming to highlight pitfalls in our management.
We performed a retrospective chart review of all patients who had a single-stage cranioplasty
and free-tissue transfer at our institution over the last 10 years. Thirteen patients (9 men and 4 women) with an average age of 66.5 years (range, 34-83 years) were identified. Etiology of the defects included malignancy (n = 7), osteoradionecrosis (n = 3), and infection (n = 3). The size of the bony defect averaged 103.1 cm2
(range, 12-300 cm2
procedures included reconstruction
by methylmethacrylate and titanium mesh (n = 10), methylmethacrylate only (n = 1), or mesh only (n = 2). Free flaps
used were anterolateral thigh (n = 10), latissimus dorsi (n = 2), or a rectus flap (n = 1).
Five patients (38%) developed at least 1 complication. These included 2 anastomotic problems that were successfully salvaged, 5 cases of wound dehiscence, and 1 mortality due to a respiratory event. Four patients developed a recurrence, and 2 patients required flap contouring at a second stage. Two patients had further reconstruction
using 1 (1 patient) or 2 (1 patient) additional free flaps
Given the complexity of these procedures, the high recurrence rate, and the likelihood of complications, methylmethacrylate is contraindicated in 1-stage cranioplasty
and soft-tissue reconstruction
in high-risk patients. For unfavorable local conditions (eg previous infection, radiotherapy), the surgeon can either postpone the cranioplasty
until the soft-tissue reconstruction
has healed, or use a nonanatomical titanium mesh alone. The soft-tissue flap should be harvested of larger dimensions than anticipated.