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首页> 美国卫生研究院文献>Archives of Plastic Surgery >Subtotal calvarial vault reconstruction utilizing a customized polyetheretherketone (PEEK) implant with chimeric microvascular soft tissue coverage in a patient with syndrome of the trephined: A case report
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Subtotal calvarial vault reconstruction utilizing a customized polyetheretherketone (PEEK) implant with chimeric microvascular soft tissue coverage in a patient with syndrome of the trephined: A case report

机译：使用定制化聚醚醚酮（PEEK）植入物并嵌合微血管软组织覆盖的特发性骨质疏松综合征患者的颅底小金库重建：病例报告

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The syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed—correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.
机译：头晕的综合征是一种神经系统现象，表现为由于颅内区域的丧失而导致的认知，行为和感觉运动功能突然下降。这种情况通常发生在因创伤，感染和/或肿瘤切除导致的大颅骨切除术缺陷的情况下。颅骨成形术已显示可通过使脑血流动力学和代谢正常化来逆转这些症状。但是，对于复杂和/或敌对的颅盖缺损患者，成功的重建可能很困难。我们目前的案例是一个48岁的男性，具有较大的颅骨缺损，其继发于感染的自体颅骨成形术失败，并发展为导致接近营养状态的快速神经系统恶化。经过清创术和抗生素治疗后，使用聚醚醚酮（PEEK）植入物以及游离的嵌合性背阔肌/锯齿肌前肌皮瓣转移来进行颅骨成形术，以进行血管重铺。术后早期，认知和运动技能得到了显着改善。在6个月的随访中，患者恢复了说话，行走和自我进食的能力，这与计算机X线断层扫描显示脑/心室再扩张的证据相关。根据我们的发现，我们主张延迟异体植入和总的血管化软组织覆盖是重建特发性综合症患者广泛，敌对的颅盖缺损的可行选择。

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