Subcutaneous effusion after digital shaping titanium mesh cranioplasty

doi:10.3969/j.issn.2095-4344.2014.08.025

Abstract

Abstract:

BACKGROUND: Subcutaneous effusion often occurs after digital shaping titanium mesh cranioplasty, and affects therapeutic effects.
OBJECTIVE: To explore the causes and corresponding prevention measures of subcutaneous effusion after digital shaping titanium mesh cranioplasty.
METHODS: We retrospectively analyzed the clinical data and treatment methods of 19 cases of subcutaneous effusion after digital shaping titanium mesh cranioplasty, summarized the postoperative complications and explored the effective methods for prevention and treatment of subcutaneous effusion.
RESULTS AND CONCLUSION: After active treatment, five cases of dural breakage, four cases of foreign body stimulation, three cases of getting out of bed early, three cases of early extubation, three cases of long-time operation repair, and one case of excessive use of electric knife were all cured. Dural breakage and foreign body stimulation is considered as the main causes of postoperative effusion. Patients with subcutaneous effusion were given releasing elastic bandage, aspiration, and strict bed rest. After these active treatments, patients were all cured. Subcutaneous effusion may result from single or mixed factors. The above-mentioned causes are only a part. Non-central suspension, incomplete hemostasis, and preoperative excessive collapse of the bone window are all reported to be the reasons for the occurrence of subcutaneous effusion.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: biocompatible materials, skull, edema, universal precautions

CLC Number:

R318

Zhou Jun-ge, Qiu Yong, Cen Bo, Jiang Yong. Subcutaneous effusion after digital shaping titanium mesh cranioplasty[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(8): 1301-1306.

Figures/Tables 3

2.1 参与者数量分析按意向性分析处理，19例患者均进入结果分析。 2.2 修补后临床情况 4例患者术后出现术区周围皮瓣红肿，皮下引流管引流量大，给予地塞米松10 mg静滴 1次/d，2 d后患者术区周围皮瓣红肿好转，皮下引流明显减少。 3例在术后48 h以内拔管，术后第四五天患者出现头痛，复查头部CT时发现皮下积液，给予松开弹力绷带，待积液达到皮下后行穿刺抽吸，2例抽吸1次后好转，1例抽吸2次后好转。 3例为拔管后就下床活动，拔管时引流管未见明显渗出液及血性液体，拔管时间为术后第3天，严格卧床后皮下积液缓慢吸收。 5例术中发生硬膜破损，出现皮下积液后给予松解弹力绷带，待积液达到皮下后行穿刺抽吸，严格卧床等积极处理后皮下积液逐渐吸收。 1例术后引流量少，颜色稍淡，头皮未见明显红肿，拔管后出现皮下积液，考虑为过度使用电刀。 4例修补时间在1年以上，3例术后出现了皮下积液。出现皮下积液后均给予松解弹力绷带，待积液达到皮下后行穿刺抽吸，严格卧床等积极处理后全部治愈。 2.3 皮下积液的发生原因术中硬膜破损5例(占26%)，材料刺激4例(占21%)，下床过早3例(占16%)，拔管过早3例(占16%)，术后修补时间过长3例(占16%)，过度使用电刀1例(占5%)。皮下积液发生原因与修补部位(表1)。术中硬膜破损与材料刺激为出现术后皮下积液的主要原因，其次是拔管过早、下床过早及修补时间过长，过度使用电刀最少见，出现皮下积液后均给予松解弹力绷带，待积液达到皮下后行穿刺抽吸，严格卧床等积极处理后全部治愈。 2.4 不良反应 4例术后出现局部皮肤红肿，渗出液增多，考虑机体对植入材料有排斥，给予地塞米松10 mg 静滴，密切观察术区伤口变化，4-7 d后症状自行消失，未见不耐受、需再次手术取出植入材料发生。"

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