Most skull defects are caused by open craniocerebral injury or firearm penetrating injury, and some patients have residual bone defects due to surgical decompression or diseased skull resection. In recent years, because of the prevalence of decompressive craniectomy in cases with high brain pressure caused by severe craniocerebral injury, there are many artificial huge skull defects. In fact, a considerable number of patients do not need to undergo decompressive craniectomy, and most of them are made in the process of surgery, which is not without defects.
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3) Timing of repair
The timing of skull defect repair should depend on the patient's whole body and local conditions. For example, after the simple depressed fracture is removed, the repair can be completed by one operation at the same time. However, for skull defect caused by open craniocerebral injury, cranioplasty should be considered after initial debridement and wound healing for 3-6 months. If the open wound has been infected, the repair operation should be postponed at least until the wound heals for more than half a year.
At present, the accepted surgical indications are:
1. The skull defect is more than 3 cm in diameter.
2. The defect is unsightly.
3. those who cause dizziness, headache and other symptoms for a long time.
4. Patients with meningeal-brain scar formation and epilepsy (epileptogenic focus resection is required at the same time).
5. Those whose serious mental burden affects their work and life.
For patients with incomplete debridement, local infection, intracranial lesions and increased intracranial pressure, cranioplasty should not be performed for the time being. In addition, some people are in poor general condition, have serious nerve defects and cannot take care of themselves; Or the scalp in the defect area is thin and has a large scar, so don't rush to repair it. You can temporarily protect it with a local helmet, and then consider plastic surgery when the conditions are ripe.
4) Material selection
Titanium products have sufficient mechanical strength, stable chemical properties and good tissue compatibility. The product has good paramagnetic adaptability after implantation, and does not affect CT, MRI, DSA and other examinations.
1. Three-dimensional titanium mesh
The three-dimensional design of mesh surface is easy to shape, and its excellent shaping effect is suitable for craniofacial defects in various parts.
2. The two-dimensional common titanium mesh
has good mechanical strength and is close to the implant surface.
3. 2D 3D titanium mesh (new concept)
The latest technology research and development results, unique patented mesh design, conform to structural mechanics, and integrate the respective advantages of the original 3D and 2D.
4. The mini titanium mesh
fits well with the skull, and connects the bone plate with the craniotomy quickly and firmly, and the anastomosis is good.
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7) Surgical care
1. Early care
① Closely observe the condition, vital signs and pupils, and pay attention to whether there are brain trauma, shock and other organ injuries. Brain trauma and shock should be rescued first, and then the reduction operation should be carried out after the general condition improves.
② The avulsion scalp can be preserved at low temperature, and early debridement should be performed without shock.
③ inject tetanus antitoxin.
2. Preoperative preparation
① Brain tissue should be protected from the skull defect, so as not to collide with the damaged part.
② Select materials for repairing defects, such as plexiglass, silicone rubber and nitinol, and send them to the operating room for backup before operation according to the size and shape of defects.
③ If autologous ribs or hip bones are used, skin should be prepared.
3. Postoperative care
① Close observation of vital signs and pupils, and report to the doctor in time if any abnormality is found.
② Six hours after operation, the vital signs were stable, and the patient could be placed in a semi-recumbent position to prevent subcutaneous hematoma or skin compression and necrosis in occipital ear area.
③ Pay attention to whether the dressing is loose, so as to prevent hydrops from occurring in the cavity between the model and the dura mater. If a small amount of hydrops is needed, it should be bandaged by pressure, and the cooperation of hydrops aspiration should be done well.
④ Semi-fluid should be given after operation, but chewing activities with the mouth open should be restricted.
4. Health guidance
① Do not wash your hair until the stitches are removed for one month. Do not scratch the skin of the repaired area to prevent infection, and be careful not to collide at ordinary times.
② Regular outpatient follow-up, and see a doctor at any time in case of foreign body reaction and other special circumstances.
5. Diet should be avoided
1. Patients under general anesthesia should fast on the same day, and they can enter liquid on the second day, and then gradually become semi-liquid and general food according to the situation.
2. In order to promote the patient's early recovery after operation, the patient should be given a nutritious diet with high protein, high calories and high vitamins in principle, such as beef, mutton and lean pork, chicken, fish, shrimp, eggs, and bean products, and can drink more milk, lotus root starch and fresh fruit juice, and eat more fresh vegetables and fruits.
8) surgical video
address: /player/outer_player.swf? auto=1& vid=12863246& Uid=1252318317
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