The selection of the most appropriate materials and the timing of procedures for dura, bone, and skin reconstruction in patients with wartime head injuries

During the 5-year war in former Yugoslavia 294 patients were surgically treated for head injuries at the Neurosurgical Department of the Emergency Center, Clinical Center of Serbia in Belgrade. In addition to other problems related to direct trauma of brain tissue, some specific problems related to other tissue defects and their importance in further complications which changed the final outcome have been noted. This study analyzed methods and materials used for dura, bone, and skin reconstruction in a search for better management of this problem. We conclude that for dural reconstruction in these patients the best materials are autologous (autotransplantation of periosteum, galea aponeurotica, or fascia lata) since this results in fewer complications and better results. Local skin flaps were used for small skin defects, but more extensive skin defects required larger flaps with free skin grafting of secondary defects. Both dura and skin reconstruction should be performed as soon as possible to prevent infection and other complications, but delayed surgery is recommended for bone defects. Only bone defects with diameter over 3–4 cm were treated surgically (alloplastic material, Palacos, being used) after 6–12 months in cases with no signs of infection. This strategy yielded the best results.