Simultaneous Debridement and Titanium Mesh Reconstruction in Patients with Compound Depressed Skull Fracture: A Retrospective Descriptive Study

Abstract

Introduction: Around 6% of head injuries are compound skull fractures. Not all compound fractures require surgical intervention; however, some fractures pose surgical challenges due to their location and the extension of fracture segments to adjacent dural venous sinuses. Surgical management includes thorough debridement of fractured segments, along with devitalised and contaminated soft tissues, followed by cranioplasty either in the same sitting or as a staged procedure. Aim: To analyse the results of single-stage titanium mesh reconstruction in the management of compound and comminuted skull fractures. Materials and Methods: This was a retrospective descriptive study in the Neurosurgery Department at Veer Surendra Medical Sciences and Research (VIMSAR), Burla, Sambalpur, Odisha, India, from January 2018 to June 2023 and consisting of case records of 98 patients with head injuries associated with compound skull fractures who were admitted. All patients underwent debridement followed by an immediate titanium mesh cranioplasty procedure. The standard debridement technique was followed in all cases. Patients were followed for three months after their discharge from the hospital. Clinicoradiological follow-up was conducted, and outcomes in terms of surgical site infection, titanium mesh exposure, and rejection of the prosthesis were evaluated. Data collected from patients were checked, entered, and analysed using Microsoft Excel, and results were described in percentages. Results: The mean age of the subjects was 28.48±13.79 years. The predominant mechanism of injury was Road Traffic Accident (RTA), affecting 59 (60.2%) patients. The frequency of skull fractures was significantly higher in men 91 (92.8%) patients compared to women 7 (7.2%) patients. The mean Glasgow Coma Scale (GCS) score was 13.35 at admission, while it was 14.90 at discharge. The fracture was located most commonly in the frontal region in 64 patients (65.3%), followed by the parietal region in 23 (23.5%) patients, and mixed fronto/temporo/parietal bone fractures in 11 (11.2%) patients. Approximately 41 (41.9%) patients had paranasal sinus involvement, and 69 (70.4%) patients had associated dural injury. A very low incidence of complications was observed in patients during their hospital stay and three-month follow-up. Only one patient developed a surgical site infection. One patient experienced sinus formation with intermittent discharge and subsequently required removal of the mesh, while two patients had a transient postoperative Cerebrospinal Fluid (CSF) leak. There were no incidences of immediate postoperative seizures. Conclusion: Simultaneous debridement and mesh reconstruction do not pose an increased risk of infection, contrary to previous beliefs.

Keywords

• cerebrospinal fluid
• cranioplasty
• head injury
• rhinorrhoea