Semantic Scholar extracted view of "The problem of the “sinking skin‐flap syndrome” in cranioplasty" by S. Sinking skin flap syndrome or "syndrome of the trephined" is a rare complication after a large craniectomy, with a sunken skin above the bone defect with neurological symptoms such as severe. The neuro-intensive care team should be prepared to diagnose. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been. A craniectomy is a common neurosurgical procedure in which a portion of the skull is resected, but not put back (cf. Full-text search Full-text search; Author Search; Title Search; DOI SearchThe sinking skin flap syndrome represents a less-frequent complication in patients after a decompressive craniectomy. Hereby, we report for the first time that DC patients with LD can progress to SSFS or PH. The remaining eight cases were myocutaneous LD flaps, where the skin paddle was utilized for the definitive soft tissue. The search yielded 19 articles with a total of 26 patients. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients’ head, diuresis and. Infrequently, neurologic deteriorations accompanied by sunken scalp may occur after DC. Di Rienzo A, Colasanti R, Gladi M. Although frequently presenting with aspecific. Introduction. Sinking skin flap syndrome is rare phenomenon that occurs in patients with large craniectomies. 7 Classically, SSFS tends to occur in the upright position and to resolve in the Trendelenburg position, which could help to detach. This phenomenon was first described in 1977 by two Japaneses authors, Yamaura and Makino, and defined as "the syndrome of the sinking skin- flap" (Fig. To prevent complications following decompressive craniectomy (DC), such as sinking skin flap syndrome, studies suggested early cranioplasty (CP). 2A). This usually. A typical CT finding in a patient with a sinking skin flap syndrome. BACKGROUND Sinking skin flap syndrome (SSFS) is an uncommon complication that can follow decompressive craniectomy. Zusammenfassung. Taste disorders. A 61-year-old male was. 2 published a review in 2016 based on 54 cases that found. We also evaluated the risk factors for the incidence of SSFS in DC patients with LD. Sinking skin flap syndrome with delayed motor deficits, or "motor trephine syndrome" is not well known in patients with large skull defects, where progressive neurological deterioration is associated with the sinking skin flap[4,12]. It results from an intracerebral hypotension and requires the replacement of the cranial flap. If you would like to make an appointment with an expert in the Reconstructive Craniofacial. Europe PMC is an archive of life sciences journal literature. Atmospheric pressure and gravity overwhelm intracranial pressure, leading to the depression of the scalp flap. Disabling neurologic deficits, as well as the impairment of. The inhibition of function in a portion of the brain at a distance from the original site of injury is known as “diaschisis. reported on cases of trephine syndrome, as characterized by severe headaches, dizziness, pain, adverse effects of cranial defects, and depressive symptoms that improved after cranioplasty. ST is also known as “sinking skin flap syndrome” and typically occurs in the weeks to months following operation. Patients with the classical “Motor trephine syndrome/ Sinking skin flap syndrome” following large craniectomy defects, may hugely benefit from an early cranioplasty procedure, with a reversal of features of this syndrome and early recovery of their neurological and cognitive functions. Remember me on this computer. 5 The development of symptoms is often insidious, but may be acute, and may be exacerbated by dehydration and patient positioning. The sinking skin flap syndrome is a set of neurological manifestations occurring weeks or even months after a large craniectomy performed for different reasons: severe head trauma as in the case. Sinking Skin Flap syndrome References [1] Timofeev I, Hutchinson PJ (2006) Outcome after surgical decompression of severe traumatic brain injury. The sinking flap syndrome (SFS) is one of the complications of decompressive craniectomy (DC). Europe PMC is an archive of life sciences journal literature. Furthermore, SoT is often associated with a sinking skin flap morphology, a radiologic and clinical sign . Paradoxical brain herniation, also known as sinking skin flap syndrome or syndrome of the trephined, is a rare and potentially fatal complication of decompressive craniectomy. The average reported craniectomy is 88. Sinking skin flap syndrome (SSFS) is a rare complication following large craniectomy and usually manifests as mental state decline, severe headache, seizures or focal deficits after a relatively stable and improved stage. 「外減圧後の合併症」. The sinking skin flap syndrome is a rare complication after a large craniectomy. 001). Kirk Withrow's 27 research works with 705 citations and 1,291 reads, including: Sinking skin flap syndrome in head and neck reconstruction: A case reportthe sinking skin flap following decompressive craniectomy. This usually. The sinking skin flap syndrome (SSFS) is defined as a secondary neurological deterioration which cannot be attributed to the primary illness and which occurs in the presence of a sinking skin flap. Without early identification and. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients’ head, diuresis and. . Gadde, J, Dross, P, Spina, M. A diagnosis of focal cortical dysfunction due to sinking scalp flap syndrome was made. These 2 syndromes illustrate the paradigm shift of the indications for cranioplasty, which have evolved from cosmetic. Introduction. We report a case of syndrome of the trephined that. 2017. Sinking skin flap syndrome (SSFS) is a rare neurological complication in patients with traumatic haemorrhage, stroke or cerebral oedema who undergo decompressive craniectomy to relieve increased intracranial pressure. About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features NFL Sunday Ticket Press Copyright. We report our experience in a consecutive series of 43 patients diagnosed with SFS and propose a classification. The pathophysiology of this phenomenon is not completely clear, but is felt to be related to the conversion of a closed system to an open. ICU勉強会 担当：S先生. Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. It is defined as a neurological deterioration accompanied by a flat or concave. Primary hemorrhages result from direct trauma, hypertension, coagulopathy, whereas secondary hemorrhages may result from descending transtentorial herniation from diverse etiologies. 2 became effective on October 1, 2023. We present a patient with sinking skin flap syndrome that underwent such a procedure and subsequently experienced immediate postoperative ascending transtentorial herniation and intracranial hemorrhage remote from the surgical site. In 1939, Grant et al. Hence, an early cranioplasty can serve as a. Complications following craniotomy are not uncommon and Sinking Skin Flap Syndrome (SSFS) constitutes a rare entity that may present after a large Decompressive Hemicraniectomy (DC) [ 1 ]. AU Sarov M, Guichard JP, Chibarro S. However, several groups reported higher complication rates in early CP. This sinking skin flap syndrome may develop when the fascia and flap directly come into contact with the cranial parenchyma. This condition involves sinking of the scalp on the decompressed side deep beyond the edges of the bone defect. This phenomenon may result from CSF hypovolemia, atmospheric pressure gradient that may be aggravated by CSF diversion, dehydration, and position change 4, 7). The mechanism underlying syndromic onset is not entirely. Edema continued to progress, but edema and. ・SSFSとは？. 1–5 This phenomenon may result from atmospheric pressure gradient that may be aggravated by CSF diversion, CSF hypovolemia. Disabling neurologic. The sinking skin flap syndrome (SSFS) is defined as a secondary neurological deterioration which cannot be attributed to the primary illness and which occurs in the presence of a sinking skin flap in patients with large craniectomies. Die rekonstruktiven operativen Verfahren nach Schädel-Hirn-Trauma umfassen Kranioplastiken mit autologem Kalottenstück, CAD-gefertigtem Implantat oder Polymethylmethacrylat (PMMA)-Implantat sowie Rekonstruktionen von Schädeldach und Schädelbasis mit Osteosynthesematerial aus Titan. Alteration in normal anatomy and pathophysiology can result in wide variety of symptoms including altered mental status, hemodynamic instability, and dysautonomias. After the surgery, perfect wound healing and infection control were achieved; however, severe. “Syndrome of the sinking skin-flap” secondary to the ventriculoperitoneal shunt after craniectomy. 1 It consists of a sunken skin above the bone defect with neurological symptoms such as severe headaches, mental changes, focal deficits, or seizures. Hence, an early cranioplasty can serve as a. A 20-year-old male. “Sinking skin flap syndrome” (SSFS) is defined as a secondary neurological deterioration in the presence of a sinking skin flap in patients with large craniectomies. 2 may differ. Sinking skin flap syndrome (SSFS) is an uncommon complication that can follow decompressive craniectomy. The final reference list was generated on the basis of its relevance to the topics covered in this review. ; Roehrer, S. Search 214,909,616 papers from. . A DureT hemorrhage occurring during an episode of intracranial hypotension resulted in sinking skin flap syndrome which was responsible for acute paradoxal descending transtentorial herniation and Duret hemorrhage, 10 days after large hemicraniectomy which could indicate early cranioplasty. Atmospheric pressure and gravity overwhelm. Full-text review yielded 11 articles discussing SoT and reconstructive techniques or. A 61-year-old male was. Syndrome of the trephined, “sinking skin flap syndrome,” or “paradoxical herniation” 1, 2 is a condition unique to neurosurgical patients who have undergone craniectomy. Sinking skin flap syndrome (SSFS) or "syndrome of the trephined" is a rare complication that can occur after decompressive craniectomy. It occurs from several weeks to months after decompressive craniectomy (DC). Clin Neurol Neurosurg 108: 583-585. Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly ever reported. Bone defects of the skull are observed in various pathological conditions, including head trauma and conditions. Disabling neurologic deficits, as well as the impairment of. "Syndrome of the trephined" or "sinking skin flap syndrome" is an unusual syndrome in which neurological deterioration occurs following removal of a large skull bone flap. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been described as partial aspects of the pathophysiology, a. "Syndrome of the trephined" or "sinking skin flap syndrome" is an unusual syndrome in which neurological deterioration occurs following removal of a large skull bone flap. Syndrome of the trephined, or sinking skin flap syndrome, is a rare complication following craniectomy, showing a variety of neurological symptoms that improve after cranioplasty. Email. Introduction. Scientific Reports - Cranial defect and pneumocephalus. Ann. Sunken Flap Syndrome. Grantham coined the term “the post traumatic syndrome” to describe similar subjective symptoms to that of “syndrome of the trephined. Sinking skin flap syndrome (SSFS), or syndrome of the trephined (ST), is characterized by the development of new neurological symptoms following decompressive craniectomy (e. Full-text search Full-text search; Author Search; Title Search; DOI SearchThe sinking skin flap syndrome (SSFS) or syndrome of the trephined is a rare complication that occurs in approximately 10% of large craniectomies and tends to develop several weeks to several months after surgery. Initial series of patients with this syndrome were small, to. Authors present a case series of three patients with. Sinking skin flap syndrome is defined as a series of neurologic symptoms with the skin depression at the site of cranial defect, which develop several weeks to months after large external cerebral. 3109/02688697. Sinking skin flap syndrome, or syndrome of trephined, seems as a DC-related complication in the first several weeks and months after DC. TLDR. Korean J Neurotrauma. The procedure is thought to convert cranium from a closed to an open box, hence altering the basic pathophysiology. Teaching point: Sinking skin flap syndrome is a medical emergency that rarely complicates large craniectomy. He had been continuously taking 75 mg of clopidogrel bisulfate daily after decompressive craniectomy for the acute cerebral infarction and discontinued the medication 7 days before cranioplasty. It appears in the weeks or months (3 months in average) after the surgery and is characterized by a neurological deterioration, not explained by other etiologies. Introduction: The sinking skin flap syndrome is a complication of decompressive craniectomies. Background: Sinking Skin Flap Syndrome (SSFS) is a postoperative phenomenon that occurs in decompressive hemicraniectomy patients after sustaining brain injury. Taste disorders can be induced by a variety of causes, while those due to central lesions are rare. Syndrome of the Trephined (SOT) or sinking skin flap syndrome is a known but rare complication following large craniectomy. Sinking skin flap syndrome, resulting from decompressive craniectomy, is defined as a series of neurologic symptoms with skin depression at the site of cranial defect. Also known by other names such as syndrome of the “trephined,” it consists of sunken skin above the bone defect along with neurological. It is of relevance not only due to its frequency, it is often underdiagnosed, but also because of the possibility. Background: Sinking skin flap syndrome or paradoxical brain herniation is an uncommon neurosurgical complication, which usually occurs in the chronic phase after decompressive craniectomy. Methods: Retrospective case series of craniectomized patients with and without SSS. Commonly, it is associated with sinking of the skin near the bone-free area. The problem was considered to have been asymptomatic sinking skin flap syndrome (SSFS). Sinking skin flap syndrome, also known as “syndrome of the trephined,” is an uncommon complication after decompressive craniectomy. Syndrome of the trephined (ST), also termed “sinking skin flap syndrome” and “paradoxical brain herniation,” describes the reversible event of neurological deterioration following craniectomy, typically within the weeks to months following the operation [1]. On determining that the subgaleal drain was the responsible cause, it was immediate removed, and the patient had. Sinking skin flap syndrome is defined as a series of neurologic symptoms with the skin depression at the site of cranial defect, which develop several weeks to months after large external cerebral. DOI: 10. Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. This is a complication that occurs in patients with large cranial defects following a DC. "Sinking skin flap syndrome" (SSFS) is defined as a secondary neurological deterioration in the presence of a sinking skin flap in patients with large craniectomies. A patient of sinking brain and skin flap syndrome. A patient of sinking brain and skinIntroduction: Complications following craniotomy are not uncommon and Sinking Skin Flap Syndrome (SSFS) constitutes a rare entity that may present after a large Decompressive Craniectomy. craniotomy in which the bone flap is re-attached to the surgical defect) 1. Sinking Skin Flap Syndrome . Accordingly, cranioplasty can be undertaken as soon as necessary. Although frequently presenting with aspecific symptoms, that may be underestimated, it can lead to severe and progressive neurological deterioration and, if left untreated, even to death. Decompressive craniotomy. The sinking bone flap syndrome may present initially with protean manifestations that may be related to changes in posture and may not show up on conventional imaging done in a supine posture. The syndrome of the sinking skin flap was introduced to explain neurological deterioration after decompressive craniectomy3. Fig. Both autologous bone flaps and alloplastic substitutes have been surgically explored over time to achieve the pre-morbid contour and eliminate the existing and anticipated complications like the “Sinking flap Syndrome”. Introduction . 2021, Anesthesia and Critical Care. Therefore, it is important to. Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves. Sinking skin flap syndrome (SSFS) is a rare neurological complication in patients with traumatic haemorrhage, stroke or cerebral oedema who undergo decompressive craniectomy to relieve increased intracranial pressure. Background: The sinking skin syndrome (SSS) is a particular complication after a decompressive craniectomy (DC). Thus, there is growing evidence that the incidence of SoT might be underestimated because of a lack of. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been described as partial aspects of the pathophysiology, a. In 1939, Grant et al. and PsycINFO databases used the key words "syndrome of the trephined" and "sinking skin flap. The sinking skin flap syndrome may progress to "paradoxical herniation" as a consequence of the atmospheric pressure exceeding intracranial pressure and may eventually lead to coma and death 6). INTRODUCTION. Lastly, reconstruction of the dura defect and dead space with a musculocutaneous flap creates a large donor site defect. The case of a 28-year-old female with the sinking skin flap syndrome is reported together with the evaluation of cerebral blood flow using. An absent cranium allows for external compression via atmospheric pressure, causing alterations in cerebral blood flow, cerebral spinal fluid. Google Scholar PubMedSunken Skin Flap Syndrome (or Syndrome of the Trephined) following a head trauma is rare, but most often results from complications after decompressive craniectomy. Sinking skin flap syndrome (SSFS) or paradoxical herniation (PH) is a rare complication and sporadically occurs in patients after DC. Cranioplasty using an original bone flap,. Aphasia precipitated by adoption of erect posture was the uncommon and easily identifiable neurological finding in this patient that drew our attention to the fact that he might be having the “sinking scalp flap syndrome. View full size version of Sinking skin flap syndrome. The sinking skin flap syndrome (SSFS) is defined as a secondary neurological deterioration which cannot be attributed to the primary illness and which occurs in the presence of a sinking skin flap in patients with large craniectomies. Sinking skin flap syndrome (SSFS) is a rare complication following large craniectomy and usually manifests as mental state decline, severe headache, seizures or focal deficits after a relatively stable and improved stage. Four days after his cranioplasty, follow-up CT images showed reversal of the midline shift with no significant complications in the underlying brain . Diagnosis In 1977 Yamura and Makino coined the term “syndrome of the sunken skin flap” to describe the neurological symptoms due to a craniectomy defect, and early cranioplasty has been recommended. Here, we demonstrate two cases of SSFS to emphasize the importance of timely diagnosis to avoid lethal sequelae of this phenomenon if not detected. Expand. Craniectomy. ” Syndrome of the trephined had an overall frequency of 10 % (43/425) following DC [25, 27, 38, 101, 103]. The aim of the procedure was to improve cosmesis and protect the brain and avoid sinking skin flap syndrome which is a rare complication of decompressive craniectomy characterized by a sunken skin flap, neurological deterioration, and paradoxical herniation of the brain. Right MCA Infarct 4. ” In the 1970s, Yamaura and Makino used the term “syndrome of the sinking scalp flap” to describe the objective focal neurological deficits that can occur in patients with a hemicraniectomy defect and. Patients with the classical “Motor trephine syndrome/ Sinking skin flap syndrome” following large craniectomy defects, may hugely benefit from an early cranioplasty procedure, with a reversal of features of this syndrome and early recovery of their neurological and cognitive functions. Five studies of TBI patients referred to the “syndrome of the trephined” or “sinking skin flap syndrome. As the herniated brain tissue recedes, the skin flap from the surgical site can become sunken. After that, sinking skin flap syndrome has been reported fairly in the literature. Sinking skin flap syndrome is a craniectomy complication characterized by new neurological dysfunction that typically worsens in the upright position and improves after cranioplasty. Search life-sciences literature (43,080,284 articles, preprints and more) Search. This syndrome is associated with sensorimotor. Intensive Care Med. The problem was considered to have been asymptomatic sinking skin flap syndrome (SSFS). Thus, there is growing evidence that the incidence of SoT might be underestimated because of a lack of. . 2010; 41:560–562 Link Google Scholar; 23. The characteristic phenomenon would be described as “the syndrome of the sinking skin flap, ” considering that neurological deterioration may be due solely to effect of concave deformity of the skin flap upon the underlying. The sinking skin flap syndrome (SSFS) is a rare complication that occurs in patients with large cranial defects following a decompressive craniectomy (DC). Disabling neurologic deficits, as well as the impairment of. 2012 Oct;8(2):149-152. It results from the pressure difference between the atmospheric pressure and the intracranial pressure causing the brain to shift inward at the craniectomy site. The sinking skin flap syndrome (SSFS) is defined as a secondary neurological deterioration which cannot be attributed to the primary illness and which occurs in the presence of a sinking skin flap in patients with large craniectomies. In the two cases presented here, however, large cranial defects after DC resulted in a sunken scalp with neurologic deterioration. A 77-year-old male patient with an acute subdural hematoma was treated using a. The case of a 28-year-old female with the sinking skin flap syndrome is reported together with the evaluation of cerebral blood flow using xenon computed tomography (CT). g. It results from the pressure difference between the atmospheric pressure and the intracranial pressure causing the brain to shift inward at the craniectomy site. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients' head, diuresis and. Complications following craniotomy are not uncommon and Sinking Skin Flap Syndrome (SSFS) constitutes a rare entity that may present after a large. This usually. It consists of a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or seizures. Europe PMC is an archive of life sciences journal literature. The sinking skin flap syndrome represents a less-frequent complication in patients after a decompressive craniectomy. ・感染. Hallmark of SSFS is the sinking of the scalp to a plane lower than the edges of the skull defect in the setting of neurological. Europe PMC is an archive of life sciences journal literature. doi: 10. Sinking skin flap syndrome or “syndrome of the trephined” is a rare complication after a large craniectomy, with a sunken skin above the bone defect with. Log in with Facebook Log in with Google. See full list on radiopaedia. Sinking skin flap syndrome (SSFS) is a rare complication of decompressive craniectomy (DC) and causes a wide range of neurological deficits. It appears in the weeks or months (3 months in average). Even less common is the development of SSFS following bone resorption after cranioplasty with exacerbation by a ventriculoperitoneal (VP) shunt. It is defined as a neurological deterioration accompanied by a flat or concave. In a study of 108 patients performed back in 2008 who underwent decompressive crainectomy, syndrome of trephined was reported in 13% of patients between 28 and. BACKGROUND Sinking skin flap syndrome (SSFS) is an uncommon complication that can follow decompressive craniectomy. The syndrome of the sinking skin flap was introduced to explain neurological deterioration after decompressive craniectomy3. Spontaneous bone healing occurred in all the survived cases and completed several months after surgery due to the difference of age (Fig. Disabling neurologic deficits, as well as the impairment of overall mental status with the development of a concave deformity and relaxation of the skin flap, are frequently observed. An absent cranium allows for external compression via atmospheric pressure, causing alterations in cerebral blood flow, cerebral spinal fluid flow, and glucose. Sinking skin flap syndrome is a rare complication of decompressive craniectomy characterized by a sunken skin flap, neurological deterioration, and paradoxical herniation of the brain. Sinking Skin Flap Syndrome: Cause of Secondary Neurological Deterioration. This phenomenon known as sinking skin flap syndrome or syndrome of trephined is a retroactive diagnosis rendered when a patient has reversal of postcraniectomy symptoms (described below) following cranioplasty. Als Sinking-Skin-Flap-Syndrom (Syndrom des sinkenden Hautlappens, SSFS) wird die Symptomkombination aus Einsinken des Hautlappens und des darunter liegenden Hirnparenchyms im Bereich einer großen Kraniektomie und einer sekundären neurologischen Verschlechterung, unabhängig von der primären Erkrankung, bezeichnet. During his irst follow-up at theSinking skin flap syndrome with delayed dysautonomic syndrome—An atypical presentation . We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. The mechanism underlying syndromic onset is poorly understood. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been described as partial aspects of the pathophysiology, a. The symptoms following large craniectomy were reported to described the "syndrome of the trephined (ST)"or "sinking skin flap syndrome (SSFS)" 13, 27, 30), while Gardner (1945) 12) reported clinical improvement after cranioplasty with tantalum repair. TLDR. However, several groups reported higher complication rates in early CP. Sinking flap syndrome revisited: the. It consists of a sunken scalp above the bone defect with neurological symptoms. Secondary Effects of CNS Trauma. Europe PMC is an archive of life sciences journal literature. The prevalence and characteristics of SSF syndrome after hemicraniectomy for malignant infarction of the middle cerebral. This phenomenon may result from CSF hypovolemia, atmospheric pressure gradient that may be aggravated by CSF diversion, dehydration, and position change 4 , 7) . (d) Flap re-suturing was then easily obtained. Sinking skin flap syndrome is a rare complication of decompressive craniectomy characterized by a sunken skin flap, neurological deterioration, and paradoxical herniation of the brain. OBSERVATIONS A 56-year-old male sustained a severe traumatic brain injury and subsequently underwent an emergent decompressive. “Sinking Skin Flap Syndrome” (SSFS) is a syndrome that can be suspected when a series of neurological symptoms are found along with skin depression at the s kull defect. 1 It consists of a sunken skin above the bone defect with neurological symptoms such as severe headaches, mental changes, focal deficits, or seizures. Although changes in cerebrospinal fluid (CSF) hydrodynamics, cerebral blood flow and brain metabolism have been described as partial aspects of the pathophysiology, a. Results. Han PY, Kim JH, Kang HI, Kim JS. In a recent work concerning 43 patients admitted for SSFS after DC, Di Rienzo et al. It is characterized by the appearance of new neurological symptoms following the craniectomy, which are relieved after cranioplasty. Syndrome of the trephined (ST) refers to the rare, reversible event of neurological deterioration following craniectomy. No. The syndrome of the “trephined” or the “sinking skin flap” (SSF) syndrome is a rare complication after a large skull bone defect. Background: Sinking skin flap syndrome or paradoxical brain herniation is an uncommon neurosurgical complication, which usually occurs in the chronic phase after decompressive craniectomy. DOI: 10. Sinking skin flap syndrome (SSFS) is a complication among long-term survivors of stroke or traumatic brain injury treated by decompressive craniectomy. Cranioplasty was performed on the right side, however during the recovery phase the patient became obtunded, encephalopathic and bradycardic. Sinking skin flap syndrome, also known as “syndrome of the trephined,” is an uncommon complication after decompressive craniectomy. Neurologic. Syndrome of the trephined, or sinking skin flap syndrome, is a rare complication following craniectomy, showing a variety of neurological symptoms that improve after cranioplasty. Case presentation • Young male patient , 32 years old • He had Right MCA territory infract 3. 2 cm(2) versus 88. We then performed cranioplasty with a titanium mesh and omental flap on day 31. Sinking skin flap syndrome in the multi-trauma patient: a paradoxical management to TBI post craniectomy. It should be suspected in all patients who had skull surgery and present with new onset neurological deterioration and dysautonomic symptoms. or reset password. This condition involves sinking of the scalp on the decompressed side deep beyond the edges of the bone defect. 19 Syndrome of Trephine • Sinking skin flap syndrome. It occurs when atmospheric pressure exceeds intracranial pressure at the craniectomy defect. edu Academia. J Surg Case Rep. (f) One month after revision a sinking flap syndrome developed. We present a 33-year-old man who experienced hemiparesis in the upright position after craniectomy. This usually. Trephine syndrome, also known as the sinking skin flap syndrome, is a relatively late complication in post-craniectomy patients. 9) Following. Fig. We report a unique case presenting with these complications immediately after decompressive craniectomy for severe traumatic brain injury. The neurological status of the patient can occasionally be strongly related to posture. "Sinking skin flap syndrome" (SSFS) is defined as a secondary neurological deterioration in the presence of a sinking skin flap in patients with large craniectomies. Sinking skin flap syndrome and paradoxical herniation after hemicraniectomy for malignant hemispheric infarction. Del Med J. Although it is very rare, sinking skin flap syndrome may lead to paradoxical brain herniation. Perfusion magnetic resonance imaging showed subclinical sinking skin flap syndrome, and he underwent cranioplasty on postoperative day 58. Als Sinking Skin Flap Syndrom wird die Symptomkombination aus Einsinken des Hautlappens und des darunter liegenden Hirnparenchyms im Bereich einer großen Kraniektomie, wie beispielsweise bei einer Hemikraniektomie und einer sekundären neurologischen Verschlechterung, unabhängig von der primären Erkrankung, bezeichnet. Besides, the traditional managements reducing the intracranial pressure for herniation may exacerbate paradoxical herniation, therefore, timely diagnosis and correct treatments are significantly important. The subsequent neurological workup for TIA, including normal Duplex carotid vertebral ultrasound, was unremarkable. It seems logical that longer times-to-cranioplasty would promote the neurologic compromise associated with the syndrome of the sinking skin flap [4, 11, 13, 14]. Exposed to a higher. 1: (A – C) Axial CT images showed sinking skin flap on the left side of the cranium, characterized by the depressed meningocele complex at the craniectomy site. Bensghir Mustapha. Lumbar drainage was performed; however, sinking skin flap syndrome was observed. 7. Krupp et al. This may result in subfalcine and/or transtentorial herniation. Sinking skin flap syndrome, often called as the “syndrome of trephined,” is a rare complication after a large craniectomy. AU Sarov M, Guichard JP, Chibarro S. As a delayed complication following bone flap removal for subdural empyemas or epidural abscesses, sinking skin flap syndrome has been widely reported. Sinking skin flap syndrome or “syndrome of the trephined” is a rare complication after a large craniectomy, with a sunken skin above the bone defect with neurological symptoms such as severe headache, mental changes, focal deficits, or seizures. he syndrome of the “trephined” or the “sinking skin flap” (SSF) syndrome is a rare complication after a large skull bone defect. 3 ± 34. back in 1977. Sinking skin flap syndrome, resulting from decompressive craniectomy, is defined as a series of neurologic symptoms with skin depression at the site of cranial defect. Schorl, M. Sinking skin flap syndrome (SSFS) or “syndrome of the trephined” is a rare complication that can occur after decompressive craniectomy. 51. Complications following craniotomy are not uncommon and Sinking Skin Flap Syndrome (SSFS) constitutes a rare entity that may present after a large Decompressive Craniectomy. Suzuki N, Suzuki S, & Iwabuchi T (1993). Its pathophysiology remains debatable, however cranioplasty may decrease the symptoms of SSFS by reducing the direct effect of atmospheric pressure on the brain and allowing the. Imaging Findings. 3. Therefore, in a patient with decompressive craniectomy, lumbar drainage or shunt surgery carries a risk to cause sinking skin flap syndrome (SSFS) or trephined syndrome, progressing to paradoxical. (e) Intraoperative positioning of a contralateral external ventricular shunt was needed to reduce flap tension allowing uncomplicated re-suturing. Once the computed tomography scan shows malignant cerebral swelling, the patient is expected to have a poor prognosis. CT perfusion imaging in the syndrome of the sinking skin flap before and after cranioplasty [Case Reports]. 5 The development of symptoms is often insidious, but may be acute, and may be exacerbated. Sinking skin flap syndrome (SSFS) or "syndrome of the trephined" is a rare complication that can occur after decompressive craniectomy. The sinking skin flap syndrome (SSFS) is defined as a secondary neurological deterioration which cannot be attributed to the primary illness and which occurs in the presence of a sinking skin flap in patients with large craniectomies. Management is largely conservative. MTS is. The sinking skin flap syndrome represents a less-frequent complication in patients after a decompressive craniectomy. His condition was generally improved. Appointments Appointments. The sinking skin flap syndrome (SSFS) is a rare complication after a large craniectomy. It is defined as a neurological deterioration accompanied by a flat or concave. The syndrome of the sinking skin flap was introduced to explain neurological deterioration after decompressive craniectomy 15). 1. Search terms “syndrome of the trephined” and “sunken flap syndrome” were applied to PubMed to identify primary studies through October 2021. Skip to search form Skip to main content Skip to account menu. It occurs when atmospheric pressure exceeds intracranial pressure at the craniectomy defect. ・広範な外減圧術後の稀な合併症. This avalanche of pathologic events may lead to neurologic worsening associated with a marked skin depression on the side of DC, which was introduced in 1977 as the “sinking skin flap syndrome” (SSFS). Isago T, Nozaki M, Kikuchi Y, et al. This report intends to describe an uncommon case of a. [1] The sinking skin flap syndrome (SSFS), or. The syndrome of the sunken skin flap: a neglected potentially reversible phenomenon affecting recovery after decompressive craniotomy. Alteration in normal anatomy and pathophysiology can result in wide variety of symptoms including altered mental status, hemodynamic instability, and dysautonomias. Sinking skin flap syndrome is a rare and potentially fatal complication of a decompressive craniectomy.