Page 140 - Clinical relevance of current materials for cranial implants

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Chapter 7
ABSTRACT
Background: Cutaneous squamous cell carcinoma is a common type of malignant skin disorder. An uncommon feature is local bony invasion, as can rarely be seen in lesions on the scalp. The optimal treatment strategy in these rare cases is still under debate.
Objective: The aim of this case report is to present a one stage 3D planned surgical resection and reconstruction of a cutaneous squamous cell carcinoma with bony invasion into the scalp and to discuss the alternative options and potential pitfalls.
Materials and Methods: A patient diagnosed with rT4N0M0 cutaneous squamous cell carcinoma of the scalp underwent a cranial resection and reconstruction in one stage. With the use of Computer-Assisted-Design and Computer-Assisted-Manufacturing a Patient Specific Implant (PSI) of Poly (Ether Ether Ketone) was manufactured. After the PSI was inserted, it was covered with a latissimus dorsi muscle and a split-thickness skin graft.
Results: Intra-operatively the resection template generated an accurate resection and accurate and fast placement of the PSI. The reconstruction had a clinical satisfactory esthetic result, but was hampered by the development of a small wound dehiscence was observed over the postoperative course.
Conclusion: 3D planned resection and reconstruction for composite defects of the skull after resection of a cutaneous squamous cell carcinoma of the scalp with bony invasion may lead to an accurate and predictable resection and accurate and fast placement of the PSI. However, patient specific characteristics should be considered to assess potential risks and benefits before opting for this one- stage treatment strategy.