Therapeutic strategies for retention of cranioplasty titanium mesh after mesh exposure

BACKGROUND: Titanium mesh exposure after cranioplasty is a possible complication and is usually managed by mesh removal and flap transfer, but the advantages of the rigid prosthesis are then lost. This study aimed to present our experience with negative pressure wound therapy combined with soft tissue dilation for retaining the titanium mesh in patients with mesh exposure after cranioplasty. METHODS: This retrospective study included patients treated between 01/2016 and 05/2019 at the Jiangyin Hospital Affiliated to Southeast University School of Medicine. The wound was cleaned, and a cystic space was created for the tissue dilator, which was used with a self-designed negative pressure dressing. After the target dilation was achieved, the repair was conducted while retaining the titanium mesh. RESULTS: Eight patients were included (seven males and one female; 53.6 ± 8.8 (range, 43–65) years of age). The exposed mesh area ranged from 1 × 1 to 4 × 5.5 cm. The thinning scalp area around the exposed mesh ranged from 3.6 × 3.8 to 4 × 5.5 cm. Five patients had positive wound cultures and received sensitive antibiotics. The dilator embedding time was 20–28 days. The time of negative pressure wound therapy was 25–33 days. The hospital stay was 30–41 days. Primary wound healing was achieved in all eight patients. There were no signs of recurrence after 6–18 months of follow-up. The cranial CT scans were unremarkable. CONCLUSIONS: Negative pressure wound therapy combined with soft tissue dilation for exposed titanium mesh after cranioplasty might help retain the titanium mesh.