Plastic surgery of dura mater defects in case of performing re-operations for gunshot wounds of the skull and brain

In complicated medico-technical warfare conditions, neurosurgical care for combat- related traumatic brain injury is not always finished at first and sometimes re-operations have been done. During re-ops, a defect of dura mater is often revealed. The choice of appropriate surgery for its closure is crucial for preventing liquorrhea and infectious complications in the post-op period. The aim of this study was to comprehend the frequency and methods of duraplasty during reoperations. A retrospective study of 100 re-ops was conducted at the neurosurgical center named after Vishnevsky National Medical Research Center for Military Medical Technology. Data were collected in the study group of combatants with a leading combat traumatic brain injury with supratentorial penetrating wound and a postoperative catamnesis of 10 days. As primary endpoint of the study the post- op liquorrhea was selected. Of the 100 re-op cases, a dural defect was detected in 83 cases (83 %). Four groups were identified: 1 (n= 14) (17 %) combatants with cerebrospinal fluid leakage and risk of developing superficial infectious complications, who underwent re-op consisted of wound revision and suturing dura defect, 2 (n= 33) (40 %) combatants with a small- sized trepanation skull window, who underwent re- op in terms of decompressive craniectomy with extended duraplasty, 3 (n= 17) (20 %) combatants with brain tissue prolapse into the trepanation window and concomitant dislocation syndrome with presence of a compressed intracranial mass lesion, who underwent revision of postoperative wound with removal mass lesions and combined auto- alloduraplasty, 4 (n= 19) (23 %) combatants with parabasal injury and developed deep infectious complications requiring re- op by way of abscess drainage, combined duraplasty with auto- allografts. These surgical approaches allowed achieving good outcomes. The risk for multiple re-ops and duraplasty increases greatly when parabasal wounds take placed.