Large cranial defects (70 cm2 or more) of complex geometric shapes (bifrontal or involving supraorbital ridges) that are associated with significant cutaneous contracture or soft tissue loss are challenging to reconstruct. We have treated 10 patients with complex cranial defects through a staged approach. Reconstructing the defect involved several steps. Before each surgery, we constructed a craniofacial prosthesis from polymethyl methacrylate to fit the patient's individual defect. When indicated, adjacent skin was expanded with a subcutaneous tissue expander. Finally, we carried out a cranioplasty and placed the prosthesis. Operative closure of the defect was facilitated by microplate and screw fixation with minimal prothesis contouring. Secure, vital, nontension skin closure was performed with the delayed, expanded local flap. Exposure to free polymer and exothermic reaction was avoided. Cosmetic results in these patients with high-volume, geometrically complex defects were excellent. No complications occurred, and the overall operative time was shortened.
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机译：与复杂的皮肤挛缩或软组织丢失相关的复杂几何形状（双额或累及眶上脊）的大颅骨缺损（70 cm 2 或更多）具有挑战性。我们通过分阶段的方法治疗了10例具有复杂颅骨缺损的患者。重建缺陷涉及几个步骤。在每次手术之前，我们都用聚甲基丙烯酸甲酯制成了颅面假体，以适应患者的个体缺陷。当指示时，用皮下组织扩张器扩张邻近的皮肤。最后，我们进行了颅骨成形术并放置了假体。用微孔板和螺钉固定术以最小的假体轮廓促进了手术缺陷的闭合。延迟扩张的局部皮瓣进行安全，重要，无张力的皮肤闭合。避免暴露于游离聚合物和放热反应。这些具有大量，几何复杂缺陷的患者的美容效果极佳。无并发症发生，总手术时间缩短。
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