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頭蓋骨固定用チタンプレートにより術後頭皮断裂および美容上の問題が生じた3例を報告する.1例目は68歳男性,開頭術2年後に頭皮にチタンプレートが露出し,これを除去し,bioabsorbable polymerによる頭蓋形成術を施行した.2例目は74歳女性,開頭術11年後に手術部位感染でチタンメッシュによる頭蓋形成術を施行した.その後メッシュは表皮より透見され,美容上の問題がある.3例目は65歳女性,開頭術6年後に頭皮にチタンプレートが露出した.骨削除・プレート除去術を施行した.頭皮断裂の主原因はチタンによる頭皮への刺激の他,皮膚切開に伴う皮膚脆弱化や骨欠損部への頭皮陥凹と思われ,チタンプレートによる頭蓋形成で頭皮断裂の可能性がある症例には,bioabsorbable polymerの使用も考慮するべきと考えられた.
We report three cases of scalp rupture after cranioplasty using titanium plates. Case 1 is a 68-year-old man. Under the diagnosis of intracerebral hemorrhage, hematoma evacuation under endscope followed by a ventriculoperitoneal shunt was performed. Two years after the surgical intervention, his titanium plate became exposed from under the scalp. The titanium plate was removed and replaced with a bioabsorbable polymer. Case 2 is a 74-year-old female, who had surgery for a subarachnoid hemorrhage. Eleven years after the initial surgical intervention, removal of sequestrum and cranioplasty with titanium mesh was performed for her late-onset surgical site infection. After this surgical intervention, the mesh has become clearly visible through progressive skin thinning. Case 3 is a 65-year-old female, who underwent surgery for a subarachnoid hemorrhage. Six years after the surgery, the titanium plate which had been used for craniplasty at the initial surgery became exposed. Removal of the plate and scalp plasty to smooth the focally sharpened skull were performed. Scalp ruptures are usually caused by chronic stimulus caused by the titanium plate, incisional fragility of the scalp and subsidence of the scalp into the skull defect. Using a titanium plate on a curved or defected portion of the skull may also cause scalp rupture. We consider that bioabsorbable polymer may be useful to avoid these post-surgical cosmetic complications, especially in cases with these risk factors for scalp rupture.