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Plastic Surgery Case Study – PMMA Cranioplasty for Moderate Flatness of the Back of the Head

Saturday, February 21st, 2015

 

Background: Excessive flatness of the back of the head can affect women and men equally. While shorter hairstyles reveal the shape of the back of the head most clearly, women with longer hair can be similarly affected and use various hairstyling methods to camouflage it.

PMMA Cranioplasty Material Dr Barry Eppley IndianapolisThere are various materials by which the back of the head can be built up. Each has their own distinct advantages and disadvantages. PMMA bone cement has been used for many decades for various forms of inlay and onlay cranioplasty. As an onlay, PMMA is most commonly thought of as a forehead augmentation material. But it can work just as well on the back of the skull as it does on its front side.

Case Study: This 35 year-old male had long been bothered by the flatness of the back of his head. It had been present since birth and he felt that the shape of the back of his head was unusual and out of proportion to the rest of his skull shape. Building up the back of his head would help give him a more normal shape.

PMMA Occipital Cranioplasty Dr Barry Eppley IndianapolisPMMA Bone Cement Occipital Augmentation results side view Dr Barry Eppley IndianapolisUnder general anesthesia, am 11 cm long incision was made across the top of his head near the back. The occipital skull was exposed and the flatness at its superior aspect evident. Three small 1.5mm screws were placed with their heads above the surface of the bone for cement anchorage. Using 60 grams of PMMA cement mixed with antibiotic powder, the putty was applies and shaped until set to give the back of his head a more rounded shape. The scalp incision was closed with resorbable sutures.

PMMA bone cement remains an historic and proven method of occipital augmentation for treatment of moderate degrees of back of the head flatness. Because the cement must be placed as an initial putty and then shaped after application, it requires an open approach with careful attention to its symmetry of shape and edge transitions. Because the cement is initially ‘soft’ it has a limited ability to create much scalp push. This limits the amount that can be placed to 60 to 90 grams through more limited scalp incisions and flap elevations.

Case Highlights:

1) Flatness of the back of the head can be corrected by a variety of onlay augmentation methods.

2) The use of PMMA bone cement is the most cost effective form of occipital cranioplasty.

3) PMMA cement is useful for small to moderate amounts of occipital augmentation requirements.

Dr. Barry Eppley

Indianapolis, Indiana

Earthquakes and Complications in Plastic Surgery

Friday, April 18th, 2008

As I was sitting here early this morning at 5:30AM preparing for a day of plastic surgery sorting out implants and patient records, there was a peculiar silence and then a noise which caught my attention. It made me sit right up and listen…and then a subtle vibration began. And then the whole building shook for about what seemed six to eight seconds….followed by what must have a small aftershock which slowly faded away over the next 20 seconds or so. A rare earthquale indeed here in Indianapolis.
The last earthquake appreciably felt here in Indianapolis was back in 1987 if I remember correctly. It may have been about the same magnitude. (5.0 or so on the Riechter scale) Infrequent as they are, earthquakes do occur here in Indiana….go down to the Indiana State Museum and check out the eathquakes that have occurred from 1955 – 2000 here in the Midwest on one of their computer displays. The epicenter of this one was over in southern Illinois but epicenters have certainly occurred in Indiana as well.
What do earthquakes and plastic surgery have in common? They are similar in at least one aspect…infrequent events do occur in plastic surgey as well. I am speaking specifically to untoward outcomes and complications from surgery. Just like you think an earthquale couldn’t happen here, most patients never feel that any complications for surgery can happen to them. Fortunately, major complications from plastic surgery are about as uncommon as earthquakes here in Indiana.
Dr Barry Eppley
Indianapolis, Indiana

Combined Armlift and Hysterectomy Surgery at IU Health West Hospital

Monday, February 11th, 2008

Combination Gynecologic and Plastic Surgery Procedure at IU Health West Hospital in Avon, Indiana

 

As the field of medicine and surgery continues to advance, I am continually amazed at how different surgical procedures are being done, not only during the same surgery, but at exactly the same time. This is of great benefit to the patient and maximizes valuable operating room time and resources.

An example of such a case was on February 12, 2008 at the IU Health West Hospital in Avon, Indiana. A female patient was initially seen by me in Plastic Surgery for contouring of her arms to get rid of the flabby skin that inevitably results after a lot of weight loss.. She required formal arm lifts (brachioplasties) combined with liposuction of the area for improvement. She had a gynecologic issue with heavy bleeding and also needed a hysterectomy. The Gyn surgeon and myself worked out a time when we could do the surgery together. Because the operative fields were at ‘opposite ends’ so to speak, we were also able to work at the same time effectively cutting down the total operative time in half.

I have seen over the years a lot of different combinations of surgeries combined with plastic surgery, but a concurrent hysterectomy-arm lift is a new combination for me. When surgeons work together, patients benefit!

Dr Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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