2025 Poster Presentations
P263: PLATE GOING ROGUE? DELAYED WOUND COMPLICATIONS FOLLOWING REABSORBABLE MESH CRANIOPLASTY
Camille Sluder, MD1; J W Kutz, MD2; Isaac Rutel, PhD, DABR1; Alexander Bien, MD1; 1University of Oklahoma Health Science Center; 2UT Southwestern
INTRODUCTION: Various materials and techniques can be implemented during cranioplasty to reconstruct calvarial defects following skull base surgery. These include methods using autologous tissue as well as various biocompatible and bioresorbable materials. One of these options is reabsorbable poly-(d,l)-lactide mesh. We present a case of delayed wound complication after a poly-(d,l)-lactide plate was used for cranioplasty following translabyrinthine craniotomy for vestibular schwannoma resection.
METHODS: A poly-(d,l)-lactide plate was secured lateral to an abdominal fat graft placed in the craniotomy defect following resection of a vestibular schwannoma via a translabyrinthine approach. Routine postoperative care and follow-up were implemented.
RESULTS: The patient’s postoperative course was complicated by development of a pseudomeningocele managed by placement of more abdominal fat and a lumbar drain. Approximately 3 weeks later, the patient presented with a pinpoint dehiscence of the postauricular incision and concern for fat necrosis. Over an eight month period, the patient presented with repeated episodes of postauricular wound breakdown with visible auto extrusion of plate fragments that were managed in various ways.
CONCLUSION: Multiple materials can be utilized in cranioplasty including titanium mesh, calcium phosphate, tetra-calcium phosphate, hydroxyapatite, and methyl methacrylate. A resorbable plate is also a reconstructive option. In this case, the repetitive nature of the patient’s wound breakdown and the clinical appearance of the incision at each occurrence all pointed toward an adverse reaction to the resorbable plate. Rejection of a poly-(d,l)-lactide resorbable plate has not previously been described as a complication following lateral skull base cranioplasty. This case highlights the need to consider rejection, or bio-incompatability, in cases where recurrent wound breakdown is encountered postoperatively which can guide more effective early wound management in this setting.
