A 57-year-old male patient with no personal history of interest underwent surgery 22 years ago for meningioma in the frontal region.
In follow-up by the Neurosurgery Department since then without signs of locoregional recurrence, she was referred to the Maxillofacial Surgery Service for evaluation of soft tissue reconstruction in the frontal region as a sequel of complicated craniotomy years ago.
He presented numerous recurrent infections at local level with rejection of cranioplasty on three occasions and failed attempts of reconstruction with skin grafts and local flaps.
Physical examination revealed an important aesthetic frontal defect with presence of ulcerated lesions and suppuration.
The front and profile view reveal a severe loss of facial height due to the presence of an external loop of its upper third, with a considerable decrease in the curvature of the cranial vault and of the crown.
The radiological study by nuclear magnetic resonance (NMR) and computed tomography (CT) reported an anatomical deformity in the frontal region and the presence of an increase in soft tissue tissue tissue, with heterogeneous uptake and hyperintense areas, with possible fluid administration.
A meningeal enhancement was also indicated in the location of the tumour, without objective extradural effusion, signs of certis or post-parenchymal abscesses, probably secondary to aplastic anaemia.
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After these data it was decided to use frontal defect by means of a free microvascular free flap of right thigh (ALT) in an attempt to solve both aesthetic and infectious problems.
The frontal defect was exposed through a coronal approach using a previous scar.
After accessing the remaining frontal sinus, resulting from previous surgeries, it was cleaned and repaired a fistula of small dura mater size with a fascia graft of temporal muscle.
Subsequently, the fasciocutaneous ALT flap was dissected with a size of 10 x 15 cm, and an area of 7 x 5 cm was de-epithelialized. In the subcutaneous de-epithelialized area, the frontal seal was preserved.
Vascular anastomosis was performed after preauricular approach using superficial temporal vessels.
At 6 months post-intervention the flap had an optimal appearance, with excellent aesthetic and functional results.
There were no signs of infection, reabsorption or volume loss in the frontal plane, and its size and shape have been determined since the intervention.
Currently, the patient, after the recovery of his identity and the effective solution of the fistula problem, has refused a new intervention for performing cranioplasty by the Neurosurgery Service.
