The Journal of craniofacial surgery
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Decompressive craniectomy has become a critical and standard life-saving maneuver in the theater of war. The high number of patients returning with large cranial defects and complex craniofacial injuries often involving the upper orbits or associated with the sunken skin flaps are a reconstructive challenge. We present a review of our treatment protocol highlighting the evolution of decompressive craniectomy and the development of a modern cranial defect treatment algorithmic approach to reconstruct these difficult clinical cases. ⋯ Warfare-related decompressive craniectomy defects can be safely reconstructed using custom alloplastic implants with low morbidity and mortality. Risk factors that increase the rate of infection and require implant removal included orbital extension of the craniectomy defect, proximity to facial sinuses, and large contour abnormalities with corresponding large dead spaces. Staging reconstruction of high-risk cranial defects followed by definitive cranial defect reconstruction improved the likelihood of implant retention and successful cranioplasty outcome.
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In general, university-based global health initiatives have tended to focus on expanding access to primary care. In the past, surgical programs may have been characterized by sporadic participation with little educational focus. However, there have been some notable exceptions with plastic surgery volunteer missions. ⋯ Project Medishare and the University of Miami continue to operate a trauma and acute care hospital in Port au Prince. The hospital provides ongoing orthopedic, trauma, and neurosurgical expertise from the rotating teams of American surgeons and training of Haitian surgeons in modern surgical techniques. We believe that surgical residencies in the United States can improve their training programs and reduce global surgical burden of disease through consistent trips and working closely with country partners.
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Various kinds of grafts, such as autogenous bone grafts and alloplastic materials, can be used for the reconstruction of calvarial defects. The selection of the optimum material for the repair of cranial defects is the greatest problem in the reconstruction of calvarial defects. For some complex calvarial defects, simple use of autogenous bone grafts or alloplastic materials makes functional and cosmetic reconstruction difficult to achieve. Therefore, the current study uses a new method to repair complex calvarial defects. ⋯ The results of this pilot study indicate that the combined use of porous polyethylene and split calvarial bone graft may be useful for cranial reconstruction in patients with complex cranial defects.
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The separation of craniopagus conjoined twins is a very rare and complex challenge. As with many rare challenges, it presents initially as a deceptively simple problem requiring only the most basic clinical techniques. As in many reconstructive problems, this paradigm mandates that the neurosurgical team performs the separation with the plastic surgeons providing closure at the end of the separation. ⋯ There has been no CSF leak or meningitis. To our knowledge, this technique has since been applied to 2 other sets of craniopagus with similar outcomes. A review of the pertinent literature, our rationale, and methodology are discussed in this article.
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Facial injuries sustained by US military personnel during the wars in Iraq and Afghanistan have increased compared with past conflicts. Characterization of midface fractures (orbits, maxilla, zygoma, and nasal bones) sustained on the battlefield is needed to improve our understanding of these injuries, to optimize treatment, and to potentially direct strategic development of protective equipment in the future. ⋯ Midface fractures sustained in the battlefield have a high complication rate, likely as a result of the blast mechanism of injury with associated open fractures, multiple fractures, and associated injuries. These cases present unique challenges, often requiring both soft tissue and skeletal reconstruction.