Introduction: Decompressive craniectomy has been widely performed procedure in with patients of raised icp due to trauma, spontaneous hematoma or infarct. Various materials as dural substitutes have been described in literature. All of them to some extent or the other have lead to more or less degree of fibrosis thus causing difficult dissection of flap during subsequent cranioplasty as well as problems related to cosmesis post cranioplasty
Methods: We performed emergency frontotemporoparietal (FTP) decompressive craniectomy using double layer of poly propylene (PTFE) patch as dural substitute. One layer was kept under the cut edge of dura and second layer above it separating it from temporalis muscle. Subsequent cranioplasty was done in these 35 patients using autologous bone flap. The development of adhesion formation between the tissue layers, amount of blood loss and flap dissection time was recorded.
Results: During the cranioplasty, clear and smooth plane was found between the two layers of PTFE patch in all the cases.
Average flap elevation time was 18 minutes. Average blood loss was also significantly less compared to our past experience with single layer substitutes. None of our patients required bone flap removal due to infection.
Conclusions: Dural substitution using double layer poly propylene patch during decompressive craniectomy facilitates subsequent cranioplasty by preventing adhesions between intracranial components and overlying temporalis muscle and galea.
Its usage makes cranioplasty dissection faster and potentially safer leading to better cosmetic result as well as reduced blood loss.
Patient Care: It will reduce the intraoperative blood loss and provide better cosmetic results by creating better tissue plane between the two layers of PTFE patch.
Learning Objectives: By the conclusion of this sessions, one should be able to:
1. Understand the importance of using double layer dural substitute during decompressive craniectomy.
2. Discuss and further investigate the use of PTFE patch as dural substitute.
3. Reduce the operative time as well as blood loss and provide better cosmesis in patients of cranioplasty