Sinking skin flap syndrome in the multi-trauma patient: a paradoxical management to TBI post craniectomy

Author:

Hakmi Hazim1,Joseph D’Andrea K1,Sohail Amir1,Tessler Lee2,Baltazar Gerard1,Stright Adam1

Affiliation:

1. Department of Surgery, NYU Langone Health, New York, 10016, USA

2. Department of Neurosurgery, NYU Langone Health, New York, 10016, USA

Abstract

Abstract Sinking skin flap syndrome is a rare syndrome leading to increased intracranial pressure, known to neurosurgeons, yet uncommon and hardly ever reported in trauma patients. In a hospitalized trauma patient with declining neurological status, rarely do we encounter further deterioration by elevating the patients’ head, diuresis and hyperventilation. However, after craniectomy for trauma, a partially boneless cranium may be compressed by the higher atmospheric pressure, that intracranial pressure rises to dangerous levels. For such cases, paradoxical supportive management with intravenous fluid infusion, and reverse Trendelenburg positioning, is used to counteract the higher atmospheric pressure, as a bridge to definitive treatment with cranioplasty. These steps constitute an urgent and easily applied intervention to reduce further neurological deterioration, of which every trauma healthcare provider should be aware.

Publisher

Oxford University Press (OUP)

Subject

Surgery

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