Dermointegration in the exposed titanium cranioplasty: a possible protective phenomenon. Issue 1 (30th January 2021)

• Record Type: Journal Article
• Authors: Zhang, Steven Liben; Lee, Hanjing; Cai, Elijah Zhengyang; Yap, Yan Lin; Yeo, Tseng Tsai; Lim, Thiam Chye; Tan, Char Loo; Lim, Jane
• Is Part Of: Journal of surgical case reports. Volume 2021:Issue 1(2021)
• Publication Date: 2021-01-30
• Subjects: Surgery -- Periodicals; Surgery -- Case studies -- Periodicals; 617.005
• DOI: 10.1093/jscr/rjaa551
• Languages: English
• ISSNs: 2042-8812

Abstract

Abstract: Implant exposure is a known complication of titanium mesh cranioplasty and is usually managed by implant removal and/or exchange. We describe a case of exposed titanium mesh cranioplasty which was managed with implant exchange and bipedicled flap coverage, and showcase an interesting phenomenon of full-thickness skin present beneath the exposed mesh. This was confirmed on histopathology, which showed the presence of dermal appendages including pilosebaceous units and eccrine glands. We postulate that the mechanism behind this phenomenon involves islands of viable skin 'dropping' between holes in the mesh and coalescing beneath the exposed implant, as suggested by histopathology findings of nodular protrusions and varying degrees of epidermal hyperplasia. This protects the underlying dura from external infection. We propose for this phenomenon to be called dermointegration. Our findings suggest that similar cases, particularly patients who are not fit for general anaesthesia, may potentially be managed with a more conservative approach.