J Reconstr Microsurg 2009; 25(2): 089-095
DOI: 10.1055/s-0028-1090609
© Thieme Medical Publishers

Intracranial Microvascular Free Flaps

Steven Levine1 , Evan S. Garfein1 , Howard Weiner2 , Michael J. Yaremchuk3 , Pierre B. Saadeh1 , Geoffrey Gurtner4 , Jamie P. Levine1 , Stephen M. Warren1
  • 1The Institute of Reconstructive Plastic Surgery, New York University School of Medicine, New York, New York
  • 2Department of Neurosurgery, New York University School of Medicine, New York, New York
  • 3Division of Plastic Surgery, Massachusetts General Hospital, Boston, Massachusetts
  • 4Division of Plastic Surgery, Stanford University Medical Center, Stanford, California
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16. Oktober 2008 (online)


Large acquired intracranial defects can result from trauma or surgery. When reoperation is required because of infection or tumor recurrence, management of the intracranial dead space can be challenging. By providing well-vascularized bulky tissue, intracranial microvascular free flaps offer potential solutions to these life-threatening complications. A multi-institutional retrospective chart and radiographic review was performed of all patients who underwent microvascular free-flap surgery for salvage treatment of postoperative intracranial infections between 1998 and 2006. A total of six patients were identified with large intracranial defects and postoperative intracranial infections. Four patients had parenchymal resections for tumor or seizure and two patients had posttraumatic encephalomalacia. All patients underwent operative debridement and intracranial free-flap reconstruction using the latissimus dorsi muscle (n = 2), rectus abdominis muscle (n = 2), or omentum (n = 2). All patients had titanium (n = 4) or Medpor (n = 2) cranioplasties. We concluded that surgery or trauma can result in significant intracranial dead space. Treatment of postoperative intracranial infection can be challenging. Vascularized free tissue transfer not only fills the void, but also provides a delivery system for immune cells, antibodies, and systemically administered antibiotics. The early use of this technique when intracranial dead space and infection coexist is beneficial.


Stephen M Warren, M.D. 

Institute of Reconstructive Plastic Surgery, New York University Medical Center

560 First Ave, TH-169, New York, NY 10016

eMail: Stephen.Warren.MD@gmail.com