- •Foreword
- •Preface
- •Acknowledgments
- •Contents
- •Contributors
- •1.2 Forehead Augmentation
- •1.2.1 Discussion
- •1.3.1 Discussion
- •1.4 Rhinoplasty
- •1.4.1 Discussion
- •1.5 Lip Augmentation
- •1.5.1 Discussion
- •1.6 Chin and Jaw Augmentation
- •1.6.1 Discussion
- •Further Reading
- •Forehead Augmentation
- •Rhinoplasty
- •Lip Augmentation
- •Jaw Augmentation
- •2: Imaging the Postoperative Orbit
- •2.1 Eyelid Weights
- •2.1.1 Discussion
- •2.2 Palpebral Springs
- •2.2.1 Discussion
- •2.3.1 Discussion
- •2.4.1 Discussion
- •2.5.1 Discussion
- •2.6.1 Discussion
- •2.7 Strabismus Surgery
- •2.7.1 Discussion
- •2.8 Glaucoma Surgery
- •2.8.1 Discussion
- •2.9 Scleral Buckles
- •2.9.1 Discussion
- •2.10 Keratoprostheses
- •2.10.1 Discussion
- •2.11 Intraocular Lens Implants
- •2.11.1 Discussion
- •2.12 Surgical Aphakia
- •2.12.1 Discussion
- •2.13 Pneumatic Retinopexy
- •2.13.1 Discussion
- •2.14 Intraocular Silicone Oil
- •2.14.1 Discussion
- •2.15.1 Discussion
- •2.16 Orbital Tissue Expanders
- •2.16.1 Discussion
- •2.17 Orbital Exenteration
- •2.17.1 Discussion
- •2.18.1 Discussion
- •Further Reading
- •Eyelid Weights
- •Palpebral Spring
- •Frontalis Suspension Ptosis Repair
- •Strabismus Surgery
- •Glaucoma Surgery
- •Scleral Buckles
- •Keratoprostheses
- •Intraocular Lens Implants
- •Surgical Aphakia
- •Pneumatic Retinopexy
- •Intraocular Silicone Oil
- •Orbital Tissue Expanders
- •Orbital Exenteration
- •3.1.1 Discussion
- •3.2 Septoplasty
- •3.2.1 Discussion
- •3.3.1 Discussion
- •3.4.1 Discussion
- •3.5 Nasal Packing Material
- •3.5.1 Discussion
- •3.6 Rhinectomy
- •3.6.1 Discussion
- •3.7 Sinus Lift Procedure
- •3.7.1 Discussion
- •3.8 Caldwell-Luc Procedure
- •3.8.1 Discussion
- •3.9 External Ethmoidectomy
- •3.9.1 Discussion
- •3.10.1 Discussion
- •3.11 FESS Complications
- •3.11.1 Discussion
- •3.11.2 Discussion
- •3.11.3 Discussion
- •3.11.4 Discussion
- •3.11.5 Discussion
- •3.11.6 Discussion
- •3.11.7 Discussion
- •3.11.8 Discussion
- •3.11.9 Discussion
- •3.11.10 Discussion
- •3.11.11 Discussion
- •3.12 Osteoplastic Flap with Frontal Sinus Obliteration
- •3.12.1 Discussion
- •3.13 Frontal Sinus Cranialization
- •3.13.1 Discussion
- •3.14 Paranasal Sinus Stents
- •3.14.1 Discussion
- •3.15 Frontal Sinus Trephination
- •3.15.1 Discussion
- •3.16.1 Discussion
- •3.17.1 Discussion
- •3.18 Maxillary Swing
- •3.18.1 Discussion
- •Further Reading
- •Septoplasty
- •Nasal Septal Button Prosthesis
- •Nasal Packing Material
- •Rhinectomy
- •Sinus Lift
- •Caldwell-Luc Procedure
- •External Ethmoidectomy
- •Functional Endoscopic Sinus Surgery
- •FESS Complications
- •Osteoplastic Flap with Frontal Sinus Obliteration
- •Frontal Sinus Cranialization
- •Paranasal Sinus Stents
- •Frontal Sinus Trephination
- •Maxillectomy and Palatectomy
- •Maxillary Swing
- •4.1 Occipital Nerve Stimulator
- •4.1.1 Discussion
- •4.2 Tissue Expander
- •4.2.1 Discussion
- •4.3 Temporal Fossa Implants
- •4.3.1 Discussion
- •4.4.1 Discussion
- •4.5.1 Discussion
- •4.6.1 Discussion
- •4.7 Scalp Tumor Recurrence
- •4.7.1 Discussion
- •4.8 Burr Holes
- •4.8.1 Discussion
- •4.9 Craniotomy
- •4.9.1 Discussion
- •4.10 Cranioplasty
- •4.10.1 Discussion
- •4.11 Autocranioplasty
- •4.11.1 Discussion
- •4.12.1 Discussion
- •4.14.1 Discussion
- •4.15 Box Osteotomy
- •4.16.1 Discussion
- •4.17.1 Discussion
- •4.18.1 Discussion
- •4.19 Subdural Drainage Catheters
- •4.19.1 Discussion
- •4.20.1 Tension Pneumocephalus
- •4.20.5 Pseudomeningoceles
- •4.20.6 Pseudoaneurysm
- •4.20.7 Postoperative Infection
- •4.20.8 Textiloma
- •4.20.9 Sunken Skin Flap Syndrome
- •4.20.10 External Brain Herniation
- •4.20.11 Bone Flap Resorption
- •Further Reading
- •Occipital Nerve Stimulator
- •Tissue Expander
- •Temporal Fossa Implant
- •Scalp Tumor Recurrence
- •Box Osteotomy
- •Absorbable Hemostatic Agents
- •Duraplasty and Sealant Agents
- •Burr Holes
- •Craniotomy
- •Cranioplasty
- •Autocranioplasty
- •Cranial Vault Reconstruction for Craniosynostosis
- •Cranial Vault Encephalocele Repair
- •Subdural Drainage Catheters
- •Intracranial Pressure Monitor
- •Cranial Surgery Complications
- •5.1 Intraoperative MRI
- •5.1.1 Discussion
- •5.2.1 Stereotactic Biopsy
- •5.2.1.1 Discussion
- •5.2.2 Resection Cavities
- •5.2.2.1 Discussion
- •5.2.3 Ommaya Reservoirs
- •5.2.3.1 Discussion
- •5.2.4 Chemotherapy Wafers
- •5.2.4.1 Discussion
- •5.2.5 Brachytherapy Seeds
- •5.2.5.1 Discussion
- •5.2.6.1 Discussion
- •5.3.1 Prefrontal Lobotomy
- •5.3.1.1 Discussion
- •5.3.2 Pallidotomy
- •5.3.2.1 Discussion
- •5.3.3 Cingulotomy
- •5.3.3.1 Discussion
- •5.3.4.1 Discussion
- •5.3.4.2 Thalamotomy
- •5.3.5 Deep Brain Stimulation (DBS)
- •5.3.5.1 Discussion
- •5.3.6.1 Discussion
- •5.3.7.1 Discussion
- •5.3.8.1 Discussion
- •5.3.9.1 Discussion
- •5.3.10 Corticectomy
- •5.3.10.1 Discussion
- •5.3.11.1 Discussion
- •5.3.12.1 Discussion
- •5.3.13 Callosotomy
- •5.3.13.1 Discussion
- •5.3.14 Anterior Temporal Lobectomy
- •5.3.14.1 Discussion
- •5.3.15.1 Discussion
- •5.3.16 Hemispherectomy
- •5.3.16.1 Discussion
- •Further Reading
- •Intraoperative MRI
- •Brain Tumor Surgery
- •Stereotactic Biopsy
- •Resection Cavities
- •Postoperative Hemorrhagic Lesions
- •Ommaya Reservoirs
- •Chemotherapy Wafers
- •Brachytherapy Seeds
- •GliaSite Radiation Therapy System
- •Prefrontal Lobotomy
- •Pallidotomy
- •Cingulotomy
- •Thalamotomy
- •Deep Brain Stimulation (DBS)
- •Epidural Motor Cortex Stimulator
- •Neural Interface System (BrainGate)
- •Corticectomy
- •Selective Disconnection
- •Callosotomy
- •Anterior Temporal Lobectomy
- •Hemispherectomy
- •6.1 Types of Procedures
- •6.1.1 External Ventricular Drainage
- •6.1.1.1 Discussion
- •6.1.2.1 Discussion
- •6.1.3 Atypical Ventricular Shunts
- •6.1.3.1 Discussion
- •6.1.4 Ventriculosubgaleal Shunts
- •6.1.4.1 Discussion
- •6.1.5.1 Discussion
- •6.1.6.1 Discussion
- •6.1.7 Subdural-Peritoneal Shunts
- •6.1.7.1 Discussion
- •6.1.8.1 Discussion
- •6.1.9.1 Discussion
- •6.1.10 Lumboperitoneal Shunts
- •6.1.10.1 Discussion
- •6.1.11 Third Ventriculocisternostomy
- •6.1.11.1 Discussion
- •6.1.12.1 Discussion
- •6.1.13 Aqueductoplasty
- •6.1.13.1 Discussion
- •6.1.14.1 Discussion
- •6.2.1.1 Discussion
- •6.2.2.1 Discussion
- •6.2.3 Intraventricular Fat Migration
- •6.2.3.1 Discussion
- •6.2.4.1 Discussion
- •6.2.5.1 Discussion
- •6.2.6 Slit Ventricle Syndrome
- •6.2.6.1 Discussion
- •6.2.7.1 Discussion
- •6.2.8 Shunt-Associated Infections
- •6.2.8.1 Discussion
- •6.2.9.1 Discussion
- •6.2.10.1 Discussion
- •6.2.11.1 Discussion
- •6.2.12 Peritoneal Pseudocysts
- •6.2.12.1 Discussion
- •6.2.13.1 Discussion
- •6.2.14 Tumor Seeding
- •6.2.14.1 Discussion
- •6.2.15 Shunt Catheter Calcification
- •6.2.15.1 Discussion
- •6.2.16.1 Discussion
- •6.2.17.1 Discussion
- •Further Reading
- •Types of Procedures
- •External Ventricular Drainage
- •Ventriculoperitoneal Shunts
- •Atypical Ventricular Shunts
- •Ventriculosubgaleal Shunts
- •Subdural-Peritoneal Shunts
- •Lumboperitoneal Shunt
- •Third Ventriculostomy
- •Aqueductoplasty
- •Fourth Ventricular Stenting
- •Complications
- •Intraventricular Fat Migration
- •Slit Ventricle Syndrome
- •Shunt-Associated Infections
- •Shunt Malposition and Migration
- •Pseudocysts
- •Cerebrospinal Fluid Leak Syndrome
- •Tumor Seeding
- •Shunt Catheter Calcifications
- •7.1.1 Discussion
- •7.2.1 Discussion
- •7.3.1 Discussion
- •7.4.1 Discussion
- •7.5.1 Discussion
- •7.6.1 Discussion
- •7.7 Radiosurgery for Vestibular Schwannomas
- •7.7.1 Discussion
- •Further Reading
- •Anterior Craniofacial Resection
- •Transsphenoidal Resection
- •Middle Cranial Fossa Reconstruction
- •Surgical Approaches for Vestibular Schwannoma Resection
- •8.1.1 Discussion
- •8.2 Auriculectomy
- •8.2.1 Discussion
- •8.3 Auricular Reconstruction
- •8.3.1 Discussion
- •8.4.1 Discussion
- •8.5 Atresiaplasty
- •8.5.1 Discussion
- •8.6.1 Discussion
- •8.7.1 Discussion
- •8.8 Ossicular Interposition
- •8.8.1 Discussion
- •8.9.1 Discussion
- •8.10.1 Discussion
- •8.11.1 Discussion
- •8.12 Atticotomy
- •8.12.1 Discussion
- •8.13.1 Discussion
- •8.14.1 Discussion
- •8.15.1 Discussion
- •8.16 Temporal Bone Resection
- •8.16.1 Discussion
- •8.17 Cochlear Implants
- •8.17.1 Discussion
- •8.18.1 Discussion
- •8.19.1 Discussion
- •8.20.1 Discussion
- •8.21.1 Discussion
- •8.22 Labyrinthectomy
- •8.22.1 Discussion
- •8.23 Vestibular Nerve Section
- •8.23.1 Discussion
- •8.24.1 Discussion
- •8.25.1 Discussion
- •Further Reading
- •BAHA Device
- •Auriculectomy
- •Auricular Reconstruction
- •Canaloplasty and Meatoplasty
- •Atresiaplasty
- •Myringoplasty and Tympanoplasty
- •Incus Interposition
- •Ossicular Prosthesis Complications
- •Transcanal Atticotomy
- •Mastoidectomy Complications
- •Lateral Temporal Bone Resection
- •Cochlear Implants
- •Cochlear Implant Complications
- •Auditory Brainstem Stimulator
- •Repair of Perilymphatic Fistula
- •Labyrinthectomy
- •Vestibular Nerve Sectioning
- •Tube Drainage of Cholesterol Cysts
- •9.1 Vertical Ramus Osteotomy
- •9.1.1 Discussion
- •9.2 Sagittal Split Osteotomy
- •9.2.1 Discussion
- •9.3 Genioplasty
- •9.3.1 Discussion
- •9.4.1 Discussion
- •9.5 Mandibular Distraction
- •9.5.1 Discussion
- •9.6 LeFort I Osteotomy
- •9.6.1 Discussion
- •9.7 LeFort III Osteotomy
- •9.7.1 Discussion
- •9.8.1 Discussion
- •9.9 Mandibulotomy
- •9.9.1 Discussion
- •9.10 Enucleation
- •9.10.1 Discussion
- •9.11 Cyst Decompression
- •9.11.1 Discussion
- •9.12 Coronoidectomy
- •9.12.1 Discussion
- •9.13.1 Discussion
- •9.14.1 Discussion
- •9.15.1 Discussion
- •9.16.1 Discussion
- •9.17.1 Discussion
- •9.18.1 Discussion
- •9.19.1 Discussion
- •9.20.1 Discussion
- •Further Reading
- •Vertical Ramus Osteotomy
- •Sagittal Split Osteotomy
- •Genioplasty
- •Mandibular Angle Augmentation
- •Mandibular Distraction
- •Lefort I Surgery
- •Lefort III Surgery
- •Fixation of Mandible Fractures
- •Mandibulotomy
- •Enucleation
- •Cyst Decompression
- •Coronoidectomy
- •Eminectomy and Meniscal Plication
- •10: Imaging the Postoperative Neck
- •10.1 Reconstruction Flaps
- •10.1.1 Discussion
- •10.2 Neck Dissection
- •10.2.1 Discussion
- •10.3 Parotidectomy
- •10.3.1 Discussion
- •10.4.1 Discussion
- •10.5 Facial Reanimation
- •10.5.1 Discussion
- •10.6.1 Discussion
- •10.7.1 Discussion
- •10.8 Transoral Robotic Surgery
- •10.8.1 Discussion
- •10.9 Sistrunk Procedure
- •10.9.1 Discussion
- •10.10 Laryngectomy
- •10.10.1 Discussion
- •10.11.1 Discussion
- •10.12 Montgomery T-Tubes
- •10.12.1 Discussion
- •10.13 Salivary Bypass Stent
- •10.13.1 Discussion
- •10.14 Laryngeal Stents
- •10.14.1 Discussion
- •10.15.1 Discussion
- •10.16 Arytenoid Adduction
- •10.16.1 Discussion
- •10.17 Arytenoidectomy
- •10.17.1 Discussion
- •10.18 Laryngeal Cartilage Remodeling
- •10.18.1 Discussion
- •10.19 Tracheotomy
- •10.19.1 Discussion
- •10.20 Thyroidectomy
- •10.20.1 Discussion
- •10.21.1 Discussion
- •10.22 Brachytherapy
- •10.22.1 Discussion
- •10.23 Vagal Nerve Stimulation
- •10.23.1 Discussion
- •Further Reading
- •Reconstruction Flaps
- •Facial Reanimation
- •Tonsillectomy and Adenoidectomy
- •Transoral Robotic Surgery
- •Neck Dissection
- •Parotidectomy
- •Salivary Duct Stenting
- •Laryngectomy
- •Montgomery T-Tubes
- •Salivary Bypass Stents
- •Laryngeal Stents
- •Arytenoid Adduction
- •Arytenoidectomy
- •Laryngeal Cartilage Remodeling
- •Tracheotomy
- •Thyroidectomy
- •Neck Exploration and Parathyroidectomy
- •Sistrunk Procedure
- •Brachytherapy
- •Vagal Nerve Stimulation
- •11: Imaging of Postoperative Spine
- •11.1 Overview
- •11.2 Spine Decompression
- •11.2.1.1 Discussion
- •11.2.2 Laminectomy
- •11.2.2.1 Discussion
- •11.2.3 Facetectomy
- •11.2.3.1 Discussion
- •11.2.4 Microdiscectomy
- •11.2.4.1 Discussion
- •11.2.5 Laminoplasty
- •11.2.5.1 Discussion
- •11.2.6 Vertebrectomy
- •11.2.6.1 Discussion
- •11.2.7 Cordectomy
- •11.2.7.1 Discussion
- •11.3.1 Halo and Traction Devices
- •11.3.1.1 Discussion
- •11.3.2 Bone Graft Materials
- •11.3.2.1 Discussion
- •11.3.3 Implantable Bone Stimulators
- •11.3.3.1 Discussion
- •11.3.4 Odontoid Screw Fixation
- •11.3.4.1 Discussion
- •11.3.5 Occipitocervical Fusion
- •11.3.5.1 Discussion
- •11.3.6 Anterior Cervical Fusion
- •11.3.6.1 Discussion
- •11.3.7.1 Discussion
- •11.3.8 Posterior Fusion
- •11.3.8.1 Discussion
- •11.3.9 Scoliosis Rods
- •11.3.9.1 Discussion
- •11.3.10 Vertebral Stapling
- •11.3.10.1 Discussion
- •11.3.11 Vertical Expandable Prosthetic Titanium Rib (VEPTR)
- •11.3.11.1 Discussion
- •11.3.12 Interbody Fusion
- •11.3.12.1 Discussion
- •11.4.1 Total Disc Replacement
- •11.4.1.1 Discussion
- •11.4.2.1 Discussion
- •11.4.3.1 Discussion
- •11.4.4 Dynamic Facet Replacement
- •11.4.4.1 Discussion
- •11.4.5 Dynamic Rods
- •11.4.5.1 Discussion
- •11.5.1 Overview
- •11.5.2.1 Discussion
- •11.5.3.1 Discussion
- •11.5.4.1 Discussion
- •11.5.5 Cerebrospinal Fluid Leak
- •11.5.5.1 Discussion
- •11.5.6.1 Discussion
- •11.5.7 Surgical Site Infections
- •11.5.7.1 Discussion
- •11.5.8 Postoperative Neuritis
- •11.5.8.1 Discussion
- •11.5.9 Arachnoiditis
- •11.5.9.1 Discussion
- •11.5.10.1 Discussion
- •11.5.11 Postoperative Synovial Cyst
- •11.5.11.1 Discussion
- •11.5.12 Residual/Recurrent Tumors
- •11.5.12.1 Discussion
- •11.5.13 Inclusion Cysts
- •11.5.13.1 Discussion
- •11.5.14.1 Discussion
- •11.5.15 Retained Surgical Tools
- •11.5.15.1 Discussion
- •11.5.16 Gossypiboma
- •11.5.16.1 Discussion
- •11.5.17.1 Discussion
- •11.5.18 Postoperative Deformity
- •11.5.18.1 Discussion
- •11.6.1 Discussion
- •11.7 Spinal Cord Stimulators
- •11.7.1 Discussion
- •11.8 Filum Terminale Sectioning
- •11.8.1 Discussion
- •11.9.1 Vertebral Augmentation
- •11.9.1.1 Discussion
- •11.9.2 Kiva Device
- •11.9.2.1 Discussion
- •11.9.3 Sacroplasty
- •11.9.3.1 Discussion
- •11.9.4.1 Discussion
- •11.9.5.1 Discussion
- •11.9.6.1 Discussion
- •Further Reading
- •Overview
- •Laminectomy
- •Facetectomy
- •Microdiscectomy
- •Laminoplasty
- •Vertebrectomy
- •Cordectomy
- •Bone Graft Materials
- •Implantable Bone Stimulators
- •Odontoid Screw Fixation
- •Anterior Cervical Fusion
- •Posterior Fusion
- •Occiptiocervical Fusion
- •Scoliosis Rods
- •Vertebral Stapling
- •Interbody Fusion
- •Nucleus Pulposus Replacement
- •Dynamic Facet Replacement
- •Dynamic Rods
- •Cerebrospinal Fluid Leak
- •Seromas and Hematomas
- •Postoperative Infection
- •Postoperative Neuritis
- •Arachnoiditis
- •Postoperative Synovial Cyst
- •Residual/Recurrent Tumors
- •Inclusion Cysts
- •Retained Surgical Tools
- •Gossypiboma
- •Postoperative Deformity
- •Intrathecal Spinal Infusion Pump
- •Spinal Cord Stimulators
- •Filum Terminale Sectioning
- •Kiva Device
- •Sacroplasty
- •Percutaneous Spine Fusion
- •CT-Guided Epidural Blood Patch
- •12.1 Vascular Surgery
- •12.1.1.1 Discussion
- •12.1.2.1 Discussion
- •12.1.3.1 Discussion
- •12.1.4.1 Discussion
- •12.1.6.1 Discussion
- •12.1.7 Carotid Endarterectomy
- •12.1.7.1 Discussion
- •12.1.8 Carotid Body Stimulation
- •12.1.8.1 Discussion
- •12.1.9 Adjustable Vascular Clamp
- •12.1.9.1 Discussion
- •12.1.10.1 Discussion
- •12.2 Endovascular Surgery
- •12.2.7 Endovascular Reconstructive Treatment for Acute Ischemic Stroke Using Intra-arterial Thrombolysis or Embolectomy
- •12.2.10 Endovascular Stent Reconstructive Treatment for Extracranial Cerebrovascular Occlusive Disease
- •12.2.11 Endovascular Reconstructive Treatment for Active Extracranial Hemorrhage or Pseudoaneurysm
- •Further Reading
- •Vascular Surgery
- •Aneurysm and Hemostatic Ligation Clips
- •Intracranial Aneurysm Muscle Wrap
- •Vascular Malformation Surgery
- •Carotid Endarterectomy
- •Carotid Body Stimulation
- •Adjustable Vascular Clamp
- •Reconstruction of the Great Vessels
- •Endovascular Surgery
- •General Imaging Considerations Following Endovascular Cerebrovascular Procedures
- •Endovascular Treatment for Aneurysms
- •Endovascular Stent Reconstructive Treatment for Extracranial Cerebrovascular Occlusive Disease
- •Endovascular Reconstructive Treatment for Active Extracranial Hemorrhage or Pseudoaneurysm
- •Endovascular Treatment for Intracranial Venous Stenosis and Occlusion
- •Index
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4.3\ Temporal Fossa Implants
4.3.1\ Discussion
Soft tissue deficiency in the temporal fossa can produce cosmetic impairment and can result from the transposition of temporalis myofascial flaps and tumor debulking procedures, among
a
c
other surgeries. The contours of the temporal fossa can be augmented using implants, such as prefabricated porous high-density polyethylene (Fig. 4.3), silicone (Fig. 4.4), and methyl methacrylate (Fig. 4.5). The implants are usually inserted via a hemicoronal approach and can be secured using titanium screws to the underlying bone.
b
Fig. 4.3 Porous polyethylene temporal fossa implant. Axial CT image (a) shows a low-attenuation polyethylene implant with inner ridged surface positioned in the left temporal fossa (arrows). There is also left orbital exen-
teration. Axial T2-weighted (b) and axial T1-weighted (c) MR images in a different patient show a polyethylene implant in the right temporal fossa (arrows) with near- anatomic contours of the overlying scalp
4 Imaging the Postoperative Scalp and Cranium |
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Fig. 4.5 Methyl methacrylate temporal fossa implant. Axial CT image shows a heterogeneous plate implanted in the right temporal scalp soft tissues (arrow)
Fig. 4.4 Silicone temporal fossa implant. The patient has a history of neurofibromatosis and is status post tumor debulking. Axial T2-weighted MRI shows a low-intensity plate in the right temporal scalp subcutaneous tissues (arrow)
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4.4\ Mohs Micrographic Surgery
and Skin Grafting
4.4.1\ Discussion
Mohs micrographic surgery is a technique that enables skin neoplasms to be fully resected while maximizing preservation of normal tissues. Mohs surgery consists of removing the tumor via
sequential thin sections, which are concurrently examined under the microscope. The process is repeated until no remaining tumor is identified microscopically. When discernible on imaging, the defects characteristically appear as welldefined cavities in the skin and underlying soft tissues (Fig. 4.6). Large defects can be reconstructed using split-thickness skin grafts (Fig. 4.7), flaps, or synthetic materials such as AlloDerm.
Fig. 4.6 Mohs micrographic surgery. The patient has a history of basal-cell carcinoma of the scalp. Coronal CT image shows a well-defined defect in the left scalp (encircled)
a |
b |
Fig. 4.7 Split-thickness skin graft. Axial T2-weighted (a) and T1-weighted (b) MR images show that the skin graft (arrows) is thinner than the adjacent normal scalp
4 Imaging the Postoperative Scalp and Cranium |
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4.5\ |
Rotational Galeal Flap Scalp |
4.6\ |
Free Flap Reconstruction |
|
Reconstruction |
|
of Complex Scalp Defects |
4.5.1\ |
Discussion |
4.6.1\ |
Discussion |
Galeal flaps, such as the retroauricular rotation flap, can be used to cover scalp defects as large as 60% of the scalp surface area. Galeal flaps are comprised of fascia, subcutaneous tissue, and vascular components. In the early postoperative period, a remote donor site defect can be apparent, such as with “flip-flop” flaps (Fig. 4.8). Galeal flaps can incur essentially the same complications as other types of flaps, including infection, tumor recurrence, and necrosis, as well as dehiscence and alopecia.
Free flap transfer is used for repairing complex scalp defects in order to provide functional, cosmetic, and structural support when the use of skin grafts, locoregional flaps, and tissue expanders is not feasible. The latissimus dorsi myocutaneous flap is particularly useful for subtotal and total skull reconstruction, in which there is considerable dead space (Fig. 4.9). Latissimus dorsi flaps can be harvested with ribs (myo-osseocuta- neous) or combined with titanium mesh for added support. Omental flaps are another option for closing large scalp and cranium defects (Fig. 4.10). These contain mostly adipose tissues and are covered by skin grafts. Other donor tissues for free flap transfer include rectus abdominis muscle flaps, scapular flap, radial forearm flap, and anterolateral thigh flap. Vascular supply is typically obtained via anastomosis to the superficial temporal artery and vein or at times the occipital artery. Complications include delayed flap failure, which requires secondary reconstruction, neck hematoma, venous thrombosis, skull base infection, large wound dehiscence, small wound dehiscence, donor site hematoma and seroma, and cerebrospinal fluid leak.
Fig. 4.8 Galeal flap, early postoperative period. The patient has a history of infected hardware, necrotic bone, and open scalp wound. A rotational scalp flap was advanced to cover the defect after wound debridement. Axial CT image shows a left parietal skull defect covered by a rotational fasciocutaneous flap. There is surgical packing material (arrow) in the contralateral donor site
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Fig. 4.9 Latissimus dorsi muscle flap. The patient has a history of extensive squamous cell carcinoma of the scalp, with invasion of the calvarium. Axial CT image (a) shows titanium cranioplasty of the right occipital and parietal
regions and an overlying muscle flap. Characteristic muscle fibers are apparent in the flap on the axial T1-weighted MRI (b). Axial post-contrast Tl-weighted MRI (c) shows enhancement of at least some of the muscle fibers