Arch Craniofac Surg.  2017 Sep;18(3):186-190. 10.7181/acfs.2017.18.3.186.

Cranial Defect Overlying a Ventriculoperitoneal Shunt: Pressure Gradient Leading to Free Flap Deterioration?

• Joo JD
• Jang JU
• Kim H
• Yoon ES
• Kang DH

• KMID: 2390354
• DOI: http://doi.org/10.7181/acfs.2017.18.3.186

Abstract

We report a case of free flap deterioration which may have been induced by pressure gradient resulting from cranial defect overlying a ventriculoperitoneal shunt (VP shunt). The patient, male and aged 78, had a VP shunt operation for progressive hydrocephalus. Afterwards, the scalp skin flap surrounding the VP shunt collapsed and showed signs of necrosis, exposing part of the shunt catheter. After covering the defect with a radial forearm free flap, the free flap site showed signs of gradual sinking while the vascularity of the flap remained unimpaired. An agreement was reached to remove the shunt device and observe the patient for any neurological symptoms, and after the shunt was removed and the previous cranial opening filled with fibrin glue by Neurosurgery, we debrided the deteriorated flap and provided coverage with 2 large opposing rotational flaps. During 2 months' outpatient follow-up no neurological symptoms appeared, and the new scalp flap displayed slight depression but remained intact. The patient has declined from any further follow-up since.

Keyword

Decompressive craniectomy; Free tissue flaps; Ventriculoperitoneal shunt

MeSH Terms

Catheters
Decompressive Craniectomy
Depression
Fibrin Tissue Adhesive
Follow-Up Studies
Forearm
Free Tissue Flaps*
Humans
Hydrocephalus
Male
Necrosis
Neurosurgery
Outpatients
Scalp
Skin
Ventriculoperitoneal Shunt*
Fibrin Tissue Adhesive