Acta Neurochirurgica

, Volume 161, Issue 3, pp 493–499 | Cite as

Experiences with a temporary synthetic skin substitute after decompressive craniectomy: a retrospective two-center analysis

  • Lukas GrassnerEmail author
  • Franz Marhold
  • Miron Yousif
  • Andreas Grillhösl
  • Karl Ungersboeck
  • Joachim Schulz
  • Martin Strowitzki
Original Article - Neurosurgery general
Part of the following topical collections:
  1. Neurosurgery general



Decompressive craniectomy is a commonly performed procedure. It reduces intracranial pressure, improves survival, and thus might have a positive impact on several neurosurgical diseases and emergencies. Sometimes primary skin closure is not possible due to cerebral herniation or extensive skin defects. In order to prevent further restriction of the underlying tissue, a temporary skin expansion might be necessary.

Methods and material

We retrospectively reviewed patients in need for a temporary skin substitute because skin closure was not possible after craniectomy without violating brain tissue underneath in a time period of 6 years (2011–2016). With this study, we present initial experiences of Epigard (Biovision, Germany) as an artificial temporary skin replacement. We performed this analysis at two level-1 trauma centers (Trauma Center Murnau, Germany; University Hospital of St. Poelten, Austria). Demographic data, injury and surgical characteristics, and complication rates were analyzed via chart review. We identified nine patients within our study period. Six patients suffered from severe traumatic brain injury and developed pronounced cerebral herniation in the acute or subacute phase. Three patients presented with non-traumatic conditions (one atypical intracerebral hemorrhage and two patients with extensive destructive tumors invading the skull and scalp).


A total of 20 Epigard exchanges (range 1–4) were necessary before skin closure was possible. A CSF fistula due to a leaky Epigard at the interface to the skin was observed in two patients (22%). Additional complications were four wound infections, three CNS infections, and three patients developed a shunt dependency. Three patients died within the first month after injury.


Temporary skin closure with Epigard as a substitute is feasible for a variety of neurosurgical conditions. The high complication and mortality rate reflect the complexity of the encountered pathologies and need to be considered when counseling the patient and their families.


Outcome Edema Decompressive craniectomy Brain herniation Skin replacement 



Glasgow Coma Scale


Central nervous system


Cerebrospinal fluid


Computer tomography


Magnetic resonance imaging


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. After reviewing the study protocol, the ethical committees at both institutions approved the study (2018–076 and 1011/2018).


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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2019
corrected publication 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryTrauma Center MurnauMurnauGermany
  2. 2.Center for Spinal Cord InjuriesTrauma Center MurnauMurnauGermany
  3. 3.Institute of Molecular Regenerative MedicineParacelsus Medical UniversitySalzburgAustria
  4. 4.Spinal Cord Injury and Tissue Regeneration Center SalzburgParacelsus Medical UniversitySalzburgAustria
  5. 5.Department of NeurosurgeryKarl Landsteiner University of Health Sciences, University Hospital St. PoeltenSt. PoeltenAustria
  6. 6.Department of NeuroradiologyTrauma Center MurnauMurnauGermany

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