Reconstruction of Composite Skull Defects Using Mesh and Radial Forearm-Free Flap

Abstract

Composite defects of the skull can occur from trauma or excision of a primary scalp cutaneous malignancy. These defects can be extra axial or involve the dura, which would result in a cerebrospinal fluid fistula. Reconstruction of these defects can be done with soft tissue alone, but this option will not restore the protective integrity of the skull (calvarium). Consequently, attempts have been made to recreate the skull with split calvarial bone grafts plated to the outer table of the skull. Bone grafting is subject to resorption over time, especially if not well fixated. Additional techniques include rapid protyping of porous polyethylene or metallic plates. These options are foreign bodies and present a risk for rejection and secondary infection. Titanium mesh is also a way to quickly restore the outer skull contour while supporting a soft tissue flap. This is an option that can be exercised when a skull defect was not anticipated preoperatively in order to plan for a custom implant.