|| FIG. 19-14. The muscle was inset into the wound and covered with split-thickness skin grafts. Pathology was again negative for malignancy postoperatively.
FIG. 19-15. Early postoperative coverage. The muscle has provided stable coverage without dural leakage, along with excellent contour.
FIG. 19-16. Later view.
FIG. 19-17. Nine months after reconstruction, a small cystic mass was felt at the posterior aspect of the flap.
FIG. 19-18. CT scan confirmed a large semi-solid extradural mass.
FIG. 19-19. The posterior aspect of the flap was elevated, the mass debrided, and the flap advanced to close the defect. Pathology at this time was positive for squamous carcinoma. Posterior view.
FIG. 19-20. The latissimus cover has tolerated radiation therapy without breakdown.
This patient had a massive stainless steel plate over the entire frontal area to fill a bony defect secondary to craniotomy for chronic pseudomonas osteomyelitis. The patient-developed secondary draining sinuses throughout the forehead area that persisted for 3 months.
FIG. 19-21. Preoperative condition, with multiple sinus in the frontal area.
FIG. 19-22. The area is exposed through a coronal incision, with the flap folded to the left. The steel plate, which extended from one supra-auricular area to the other, is on the right.
FIG. 19-23. A large latissimus dorsi myocutaneous flap with a narrow skin island was used to fill the entire soft-tissue defect left after removal of the plate.
FIG. 19-24. The cutaneous flap is sutured to the skin edges of defect.
FIG. 19-25. Results, 5 years after reconstruction. The muscle has filled the contour defect and protected the underlying brain.
This patient had a wide area of extensive scarring and an unstable split-thickness graft on the underlying skull and dura after multiple excisions of recurrent meningioma.
FIG. 19-26. Scarring is seen in the anterior frontal and parietal areas.