Elsevier

World Neurosurgery

Volume 119, November 2018, Pages e417-e428
World Neurosurgery

Original Article
Skin Augmentation as a Last-Resort Operative Technique During Decompressive Craniectomy

https://doi.org/10.1016/j.wneu.2018.07.177Get rights and content
Under a Creative Commons license
open access

Highlights

  • Brain swelling after decompressive craniectomy may hamper skin closure.

  • Skin augmentation may be used as a last-resort measure in severe brain swelling.

  • A favorable outcome is possible when primary skin closure is not possible.

Objective

Since 2009, we have performed skin augmentation using a Gore-Tex patch as a last-resort measure to reduce intracranial pressure (ICP) in uncontrollable brain swelling during decompressive craniectomy (DC). Here, we report our experience and outcome in a consecutive series of patients undergoing DC with skin augmentation (DC+S).

Methods

In 2009–2015, a prospective database was created registering all patients who underwent DC+S when ICP increased >25 mm Hg while approximating the skin edges after DC (or when closing the skin was impossible because of uncontrollable brain swelling in patients without an ICP monitoring catheter). Patients' baseline characteristics and 1-year outcome were compared with patients undergoing DC without the need of skin augmentation in the same time frame. Outcome according to the Glasgow Outcome Scale (GOS) was dichotomized into favorable (GOS score 4–5) and unfavorable (GOS 1–3).

Results

Of a total of 180 consecutive patients with DC, 20 (11%) underwent DC+S. Four (20%) survived favorably, 2 (10%) unfavorably, and 14 (70%) died (compared with 36%, 22%, and 42%, respectively, in patients with standard DC). Four of 7 patients in whom DC+S was performed ≥24 hours after injury or at second surgery survived favorably, versus none of the 13 patients in whom DC+S was performed <24 hours after injury and at first surgery. Two of 10 patients surviving the first week after DC+S had a skinplasty-related infection.

Conclusions

Decompressive craniectomy with skin augmentation may be used as a last-resort measure in cases of severe brain swelling despite DC.

Key words

Decompressive craniectomy
Gore-Tex
Intracranial pressure
Skin augmentation
Traumatic brain injury

Abbreviations and Acronyms

CSF
Cerebrospinal fluid
CT
Computed tomography
DC
Decompressive craniectomy
DC+S
Decompressive craniectomy with skin augmentation
GCS
Glasgow Coma Scale
GOS
Glasgow Outcome Scale
ICP
Intracranial pressure
QoL
Quality of life
TBI
Traumatic brain injury

Cited by (0)

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

1

Current address: Department of Neurosurgery, Medical Spectrum Twente, Enschede, The Netherlands.

2

Current address: Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.