PMC3228391_01
Herniation of cortical tissue from linear depressed skull fracture
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F2
A reverse question mark scalp incision was utilized and a myocutaneous flap elevated, revealing a large frontoparietotemporal linear depressed skull fracture with active herniation of cortical tissue from the fracture line [Figure 2].
Thin layer of absorbable Surgicel Fibrillar dressing over the dura blankets the entire defect. Surgicel Fibrillar enhances hemostasis and is bactericidal
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F3
After hemostasis was ensured, the stellate dural flaps were laid on the brain surface and the entire defect was covered with a thin layer of Fibrillar hemostatic agent (Ethicon) [Figure 3a]. The three bone flaps were then placed on the surface of the dura/fibrillar cushion in approximate anatomic position [Figure 3b].
Technique of in situfree-floating craniectomy bone flaps positioned 5-10 mm apart on the surface of the Fibrillar cushion. Bone flaps were not affixed to each other or to the skull or underlying dura, and were designed to permit mobility for outward expansion in case of further traumatic edema
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F4
The patient had excellent cosmetic outcomes and neurological recovery, and was discharged on postoperative day 10 [Figure 4].