Multi-stage preparation for the repair of complicated skull defects

Cranioplasty following decompressive craniectomy is highly associated with complications. Methods for avoiding these complications have been well-documented; however, approaching reconstruction through the previous incision, especially if it was on or very near the bone defect, can sometimes lead to wound dehiscence and infection, with exposure of the artificial bone. For such complicated cases, we propose a multi-staged preparation that includes creating a delayed skin flap for the actual skull reconstruction. Flap was elevated in three stages, with 4 week intervals between each stage to allow for adequate blood supply. Cranioplasty using custom-made implants was then performed. Four patients (age range, 10-25 years) were prepared for skull reconstruction using this technique. During follow-up period for 12 months, no complications, including infections, exposure of the artificial bone, or flap necrosis, were observed. Despite the multiple stages required, we consider that our technique makes a significant contribution to the literature because it suggests a technique for cranioplasty following decompressive craniectomy that may avoid many of the complications following such cranioplasty using current methods.