2022 年 3 巻 2 号 p. 50-54
Cranioplasty is sometimes problematic in patients whose scalp is severely scarred, contracted, or infected. Although tissue expansion is a useful treatment technique, wound dehiscence may occur during expansion. Withdrawal of normal saline solution from the tissue expander and successive wound resuturing is a treatment option but carries the risk of wound dehiscence recurrence. Complete removal of the tissue expander is another treatment option, although it prolongs the overall treatment period. We conceived a novel method that repositions the tissue expander by 2–3 cm in a direction distal to the wound. A full-thickness skin graft was then applied to cover the skin defect created as a consequence of debridement of the dehiscent wound. The grafted skin was removed at the time of cranioplasty to minimize the hairless area. We report two cases in which our method provided esthetically satisfactory outcomes without any complications: an 11-year-old girl with a history of acute subdural hematoma and a 43-year-old man with a history of brain tumor removal. Our method is believed to have the potential to reduce the risk of recurrence of wound dehiscence and minimize the prolongation of the overall treatment period.
