Turnover periosteal flap for reconstruction of shunt-exposed scalp defects in pediatric patients

Abstract

Introduction: Shunt procedures are still the mainstream treatment for hydrocephalus. Exposure of the shunt is a serious problem, especially in pediatric patients with enlarged calvarium causing thinning of the scalp skin which makes it fragile with increased pressure points. In order not to tussle with serious complications of shunt exposure, early intervention with effective surgical strategies is important. The aim of this study is to present an effective surgical technique utilizing a turnover periosteal flap for the reconstruction of shunt exposures in pediatric patients. Materials and Methods: The study was performed retrospectively on 22 pediatric patients with shunt exposure after their primary surgery in a university hospital. Turnover periosteal flap was utilized to cover the exposed shunt hardware, and the scalp flap was transposed over the periosteal flap. Results: None of the 22 patients showed re-exposition or required revision surgery for wound dehiscence. All of the patients healed well, but one patient developed pressure ulcer over the graft recipient site requiring continuation of the conventional wound care for 2 months. None of the patients had wound dehiscence, and well recovery of the surgical incisions was observed. Conclusion: Turnover periosteal flap is a simple, quick yet very effective method in the treatment of patients with shunt exposure. It effectively reduces wound dehiscence in pediatric patients with fragile skin and prevents catastrophic complications of shunt exposure and infection.

Keywords

• double-layered scalp reconstruction
• hydrocephalus
• scalp defects
• shunt exposure
• turnover periosteal flap