Page 147 - Clinical relevance of current materials for cranial implants

Virtual surgical planning for skincancer with cranial bone invasion
Post-operative course and histology
After two days the head bandage was removed. The LD flap remained vital. There were no neurological complications in the direct postoperative course.
On the 14th postoperative day the patient collapsed and sustained direct head trauma without loss of consciousness. Neurological examination was unremarkable. A hematoma between the implant and the LD flap occurred. No surgical intervention was initiated and the hematoma resolved partially. Unfortunately a wound dehiscence of 1 x 2 cm was observed on the most distal aspect of the muscle flap where the hematoma sustained. This area was debrided and wound dressing was applied. After 21 days of hospitalization the patient went home in good condition (Figure 5A&5B). A small area of dehiscence over the implant persisted, which has remained stable during the complete first year of follow-up (Figure 5C).
The pathologic examination showed a squamous cell carcinoma of the skull with underlying bone destruction and surrounded by actinic keratosis. There were no signs of perineural spread of lymphovascular invasion. Surgical margins were free of tumor.
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Figure 5: A&B)Postoperative situation 4 months after surgery with a symmetric reconstruction of the cranial vault, which will improve as further atrophy of the muscle continues . C) Unfortunately, there is a stable dehiscence over the implant, showing on the right posterolateral side of the skull. It might be safer to perform the surgery in two phases, in order to prevent this complication.
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