• Taco Goedemans, Olivier van der Veer, Dagmar Verbaan, Maarten Bot, Michiel B Lequin, Bert A Coert, Wouter R van Furth, Gert-Joan Bouma, W Peter Vandertop, Dennis R Buis, and Pepijn van den Munckhof.
• Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
• World Neurosurg. 2018 Nov 1; 119: e417-e428.

ObjectiveSince 2009, we have performed skin augmentation using a Gore-Tex patch as a last-resort measure to reduce intracranial pressure (ICP) in uncontrollable brain swelling during decompressive craniectomy (DC). Here, we report our experience and outcome in a consecutive series of patients undergoing DC with skin augmentation (DC+S).MethodsIn 2009-2015, a prospective database was created registering all patients who underwent DC+S when ICP increased >25 mm Hg while approximating the skin edges after DC (or when closing the skin was impossible because of uncontrollable brain swelling in patients without an ICP monitoring catheter). Patients' baseline characteristics and 1-year outcome were compared with patients undergoing DC without the need of skin augmentation in the same time frame. Outcome according to the Glasgow Outcome Scale (GOS) was dichotomized into favorable (GOS score 4-5) and unfavorable (GOS 1-3).ResultsOf a total of 180 consecutive patients with DC, 20 (11%) underwent DC+S. Four (20%) survived favorably, 2 (10%) unfavorably, and 14 (70%) died (compared with 36%, 22%, and 42%, respectively, in patients with standard DC). Four of 7 patients in whom DC+S was performed ≥24 hours after injury or at second surgery survived favorably, versus none of the 13 patients in whom DC+S was performed <24 hours after injury and at first surgery. Two of 10 patients surviving the first week after DC+S had a skinplasty-related infection.ConclusionsDecompressive craniectomy with skin augmentation may be used as a last-resort measure in cases of severe brain swelling despite DC.Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

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