Dural Reconstruction in Refractory Cranial Infection using Omental Free Flap.

Yoo, Ji Han; Eun, Seok Chan; Han, Jung Ho; Baek, Rong Min

Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2009;36(5):670-673.
Published online September 1, 2009.

Dural Reconstruction in Refractory Cranial Infection using Omental Free Flap.

Ji Han Yoo, Seok Chan Eun, Jung Ho Han, Rong Min Baek

¹Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea. sceun@snubh.org
²Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Epidural abscesses and subdural empyemas after craniotomy are uncommon, potentially lethal, complications of neurosurgery. Patients with these complications may be difficult to manage and dural reconstruction in these patients are challenging. METHODS: A 28-year-old female patient showed recurrent intracranial infection after craniotomy for evacuation of a arachnoid cyst and subdural hematoma. Despite prolonged systemic antibiotic administration and a debridement of the subdural space, infection persisted, as evidenced by persistent fever, an elevated WBC count, CSF leakage, low CSF glucose level, and purulent wound discharge. The authors removed the previously applied lyophilized dura and transferred free omental flap to reconstruct the dura, obliterate the cyst and cover the cerebral hemisphere in the craniotomy defect. Microvascular anastomosis was between gastroepiploic and superficial temporal vessels.
RESULTS
The postoperative course was uneventful and flap survival was excellent. The infection-resistant omental tissue allowed sufficient blood circulation and dead space control. The patient was discharged 1 month after the surgery and wound discharge or recurrence was absent during 13 months of follow up periods.
CONCLUSION
The use of vascularized free omentum proved useful in cases of intractable cranial wound infection and cerebrospinal fluid leakages

Keywords: Omentum; Cranial infection; Free flap transfer