Strategy in Front of Complex Infected Cranial Defects Overlying Dura Mater. Feasibility and Safety of Negative Pressure Wound Therapy

Although rare, large cranial infected defects are challenging for practitioners, especially when the dura mater is involved. These complex full-thickness wounds (scalp, bone, and dura mater) commonly occur after surgery, trauma or failed reconstructive procedures. Many patients are poor candidates for immediate reconstruction because of original pathology, patient's general state, previous radiotherapy, which compromises the locally available tissue, depth of the sepsis. For these challenging patients, a two-step procedure (cleanliness then reconstruction) has to be proposed. Recently, few authors report the use of negative pressure wound therapy, NPWT, in association with a first-step cleanliness surgery with encouraging results. Methods: We report three consecutive cases with standardized two-step procedure for complex full-thickness cranial wounds. First step is a cleanliness surgery associated with NPWT using a continue negative pressure ranging from 25 to 75 mm Hg. Safety of NPWT protocol is evaluated by neuropsychological and clinical examination. A second step for reconstruction is then performed. Results: Good outcomes were achieved in all cases without any complication due to NPWT with a 9-month follow-up. No significant difference was found between neuropsychological examination with or without NPWT. Conclusion: NPWT is a safe procedure optimizing local wound conditions for poor candidates for immediate reconstruction in complex infected cranial defects overlying the dura mater.