OBJECTIVE: Patients with cranioplasty in need of skull reconstruction are at increased risk of complications when presenting with abnormally thin scalps. As such, the authors sought to develop and investigate a new technique for scalp augmentation using autologous rectus fascia grafts (ARFGs) for prevention of implant extrusion and long-term scalp durability.
METHODS: A retrospective review of our database, consisting of 450 consecutive cranial reconstructions from 2012 to 2017, was performed under institutional review board approval. Selection criteria included all adult patients requiring implant-based cranioplasty reconstruction and concomitant scalp augmentation using ARFGs. All long-term outcomes were reviewed for scalp-related complications and are presented here.
RESULTS: In total, 12 consecutive patients receiving ARFGs were identified. Average follow-up was 10 months (range = 2-17 months). Average graft size and dimension was 82 cm (range = 12-360 cm). All patients (n = 12) underwent concomitant cranioplasty reconstruction and had a history of at least 5 or greater previous neurocranial operations. Six patients had radiation therapy prior to cranioplasty. Two major complications (2/12, 17%) were identified related to deep, recurrent intracranial infections. More importantly, none of the patients (n = 12) in this study cohort developed scalp breakdown and/or implant extrusion in the areas of rectus fascia scalp augmentation.
CONCLUSION: The use of ARFGs for underlay scalp augmentation appears to be both safe and reliable based on our preliminary experience. This new approach is extremely valuable when performing large-size cranioplasty reconstruction in patients with abnormally thin scalps, an extensive neurosurgical history, and/or suboptimal tissue quality. Furthermore, this method has been successful in avoiding free tissue transfer and/or staged tissue expansion as first-line surgery in our complicated cranioplasty population.
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