A Plastic-neuro Effort: Vascularized Soft-tissue Coverage for Hostile Wound Bed with Multiple Ventricular Shunt Failures.

MedStar author(s):
Citation: Plastic and Reconstructive Surgery - Global Open. 8(11):e3257, 2020 Nov.PMID: 33299719Institution: MedStar Washington Hospital CenterDepartment: Neurosurgery | Surgery/Plastic SurgeryForm of publication: Journal ArticleMedline article type(s): Case ReportsSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2020ISSN:
  • 2169-7574
Name of journal: Plastic and reconstructive surgery. Global openAbstract: Cerebral ventricular shunt placements are the most common neurosurgical procedure performed today, which play a life-long role in the care of patients with hydrocephalus. Complication rates requiring shunt replacement are as high as 25%, and the potential need for multiple revisions throughout a patient's life may result in the formation of scar tissue and compromised wound healing. Without addition of vascularized tissue, patients with scalp scarring and impaired wound healing then enter a cycle of impaired skin closure followed by shunt infection, failure, and revision with little promise of long-term operative or therapeutic success. This plastics-neuro collaboration is the first known report of a free vastus lateralis muscle flap for coverage of a cerebral ventricular shunt, in a patient with congenital hydrocephalus and 17 previous ventricular shunts revisions due to infections and soft tissue exposure from scarring and a hostile wound bed. In the setting of extensive scarring, the free vascularized muscle flap provides soft tissue and vascular supply capable of promoting wound healing, maintaining scalp integrity, and reducing the incidence of shunt infection and the subsequent need for future revision, as supported by the complication-free status of the same patient now 16 months since the date of operation. Copyright (c) 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.All authors: Dowlati E, Economides JM, Evans KK, Fan KL, McGrail K, Meshkin DHFiscal year: FY2021Digital Object Identifier: Date added to catalog: 2020-12-31
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Journal Article MedStar Authors Catalog Article 33299719 Available 33299719

Cerebral ventricular shunt placements are the most common neurosurgical procedure performed today, which play a life-long role in the care of patients with hydrocephalus. Complication rates requiring shunt replacement are as high as 25%, and the potential need for multiple revisions throughout a patient's life may result in the formation of scar tissue and compromised wound healing. Without addition of vascularized tissue, patients with scalp scarring and impaired wound healing then enter a cycle of impaired skin closure followed by shunt infection, failure, and revision with little promise of long-term operative or therapeutic success. This plastics-neuro collaboration is the first known report of a free vastus lateralis muscle flap for coverage of a cerebral ventricular shunt, in a patient with congenital hydrocephalus and 17 previous ventricular shunts revisions due to infections and soft tissue exposure from scarring and a hostile wound bed. In the setting of extensive scarring, the free vascularized muscle flap provides soft tissue and vascular supply capable of promoting wound healing, maintaining scalp integrity, and reducing the incidence of shunt infection and the subsequent need for future revision, as supported by the complication-free status of the same patient now 16 months since the date of operation. Copyright (c) 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

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