000			02816nam a22003617a 4500
008			190823s20192019 xxu||||| |||| 00| 0 eng d
022			_a2234-6163
024			_a10.5999/aps.2018.00360 [doi]
024			_aaps.2018.00360 [pii]
024			_aPMC6657197 [pmc]
040			_aOvid MEDLINE(R)
099			_a31336426
245			_aSubtotal calvarial vault reconstruction utilizing a customized polyetheretherketone (PEEK) implant with chimeric microvascular soft tissue coverage in a patient with syndrome of the trephined: A case report.
251			_aArchives of Plastic Surgery. 46(4):365-370, 2019 Jul.
252			_aArch. plast. surg.. 46(4):365-370, 2019 Jul.
253			_aArchives of plastic surgery
260			_c2019
260			_fFY2020
265			_sppublish
266			_d2019-08-23
520			_aThe syndrome of the trephined is a neurologic phenomenon that manifests as sudden decline in cognition, behavior, and sensorimotor function due to loss of intracranial domain. This scenario typically occurs in the setting of large craniectomy defects, resulting from trauma, infection, and/or oncologic extirpation. Cranioplasty has been shown to reverse these symptoms by normalizing cerebral hemodynamics and metabolism. However, successful reconstruction may be difficult in patients with complex and/or hostile calvarial defects. We present the case of a 48-year-old male with a large cranial bone defect, who failed autologous cranioplasty secondary to infection, and developed rapid neurologic deterioration leading to a near-vegetative state. Following debridement and antibiotic therapy, delayed cranioplasty was accomplished using a polyetheretherketone (PEEK) implant with free chimeric latissimus dorsi/serratus anterior myocutaneous flap transfer for vascularized resurfacing. Significant improvements in cognition and motor skill were noted in the early postoperative period. At 6-month follow-up, the patient had regained the ability to speak, ambulate and self-feed-correlating with evidence of cerebral/ventricular re-expansion on computed tomography. Based on our findings, we advocate delayed alloplastic implantation with total vascularized soft tissue coverage as a viable alternative for reconstructing extensive, hostile calvarial defects in patients with the syndrome of the trephined.
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Washington Hospital Center
656			_aSurgery/Plastic Surgery
657			_aCase Reports
700			_aDeFazio, Michael V
700			_aTer Louw, Ryan P
700			_aWang, Jessica S
790			_aDeFazio MV, Evans KK, McGrail KM, Ter Louw RP, Wang JS
856			_uhttps://dx.doi.org/10.5999/aps.2018.00360 _zhttps://dx.doi.org/10.5999/aps.2018.00360
942			_cART _dArticle
999			_c4515 _d4515