J Korean Soc Plast Reconstr Surg.  2009 Sep;36(5):670-673.

Dural Reconstruction in Refractory Cranial Infection using Omental Free Flap

• Yoo JH
• Eun SC
• Han JH
• Baek RM

Abstract

PURPOSE
Epidural abscesses and subdural empyemas after craniotomy are uncommon, potentially lethal, complications of neurosurgery. Patients with these complications may be difficult to manage and dural reconstruction in these patients are challenging.
METHODS
A 28-year-old female patient showed recurrent intracranial infection after craniotomy for evacuation of a arachnoid cyst and subdural hematoma. Despite prolonged systemic antibiotic administration and a debridement of the subdural space, infection persisted, as evidenced by persistent fever, an elevated WBC count, CSF leakage, low CSF glucose level, and purulent wound discharge. The authors removed the previously applied lyophilized dura and transferred free omental flap to reconstruct the dura, obliterate the cyst and cover the cerebral hemisphere in the craniotomy defect. Microvascular anastomosis was between gastroepiploic and superficial temporal vessels.
RESULTS
The postoperative course was uneventful and flap survival was excellent. The infection-resistant omental tissue allowed sufficient blood circulation and dead space control. The patient was discharged 1 month after the surgery and wound discharge or recurrence was absent during 13 months of follow up periods.
CONCLUSION
The use of vascularized free omentum proved useful in cases of intractable cranial wound infection and cerebrospinal fluid leakages

Keyword

Omentum; Cranial infection; Free flap transfer

MeSH Terms

Adult
Arachnoid
Blood Circulation
Cerebrum
Craniotomy
Debridement
Empyema, Subdural
Epidural Abscess
Female
Fever
Follow-Up Studies
Free Tissue Flaps
Glucose
Hematoma, Subdural
Humans
Neurosurgery
Omentum
Recurrence
Subdural Space
Wound Infection
Glucose