Page 145 - Clinical relevance of current materials for cranial implants

Virtual surgical planning for skincancer with cranial bone invasion
Phase III - Reconstruction of the skull
Before definite placement of the PSI, six absorbable dural suspension sutures were placed to fix the dura to the PSI. Thereafter, the PSI could be positioned and fixed to the skull with osteosynthesis material (KLS Martin Group, Tuttlingen, Germany) and 10 screws of 5 mm (Figure 4D).
After fixation of the PSI, the free LD flap could be detached from its vascular pedicle and transferred to the skull. It was ensured that the PSI was completely covered by the LD flap. A vest-over-pants inset 15 was used to prevent bone exposure at the flap-scalp junction and increase the distance between the implant and wound edges (Figure 4E). The vascular pedicle was anastomosed to the recipient vessels and perfusion of the flap was controlled with a doppler ultrasonography.
Coverage of the LD flap was performed with a split-thickness skin graft from the anterolateral thigh, which was meshed (1:1.5) (Figure 4F). A local wound dressing was applied.
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