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Enrique Sanchez

on 18 July 2013

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Transcript of Cranioplasty

Care of Children and Families
Teaching Project
presented by
Enrique Sanchez

14 yr old female orbital, frontal, sphenoid fracture repair secondary to gunshot wound to head in Jan 2013.
S/P Cranioplasty - March 18, 2013
Large horseshoe incision from ear-ear crossing the top of head
Incision is open to air with staples intact
J/P drain inserted during surgery (right incision site)
Similar incision site
Titanium and molding used
Left most of hair left in place
Jackson-Pratt drain inserted
Right orbital socket repaired
This is where the bone defect in the skull
left behind after a previous operation or
injury is repaired.

What is a Cranioplasty?
The scalp is lifted and something is placed
into/over the boney defect.

The substance(s) used are:
The original bone if kept
Rib graft
Titanium mesh
Titanium plate
Synthetic bone substitute
Acrylic (prefabricated or
fabricated at time of surgery
What are the reasons for having a Cranioplasty?
A hole in the head looks unsightly.
The defect if in a certain place leaves the brain exposed and may allow damage to occur.
Sometimes headaches occur if the bone is not replaced.
In some patients there is a definite improvement in neurological function if the bone is replaced.
How is it performed?
In the operating room a general anesthetic is given and then positioned with the bone defect uppermost
The area of the incision is then shaved and prepared with antiseptic.
You are covered in drapes so that only the incision can be seen.
Local anaesthetic is injected and then the skin is cut.
The scalp is dissected from the dura and the edges of the surrounding bone are cleaned to allow the graft to stick.
If the original bone is available or a replacement has been made preoperatively then this is placed in the defect and secured either with screws and plates or with special discs
What are the common risks?
Infection (treated with antibiotics)
Post op blood clot requiring drainage
Death (rare)
Clot in legs (can travel to lungs [uncommon])
What happens next?
Recovery room
V/S will be taken often
Routine N/V checks
IM or PO analgesics available (operations on the head do not often hurt much)
Catherization may be needed if unable to void post-op.
Ambulation encouraged on post-op day 1
Over the next few days, ADLs are encouraged until comfortable.
CT of head may be repeated before discharge.
Headaches after surgery are common during recovery stage.
Staples usually removed about 5-10 days after surgery.
Nursing Diagnosis:
Risk for infection r/t tissue trauma s/p surgery and J/P drain insertion AMB incision with staples left open to air, and j/p drain.
Impaired skin integrity r/t cranioplasty incision with staples AMB open incision with j/p drain.
Disturbed body image r/t large incision, deformity of orbital socket,and presence of j/p drain AMB patient stating "I didn't think the cut was going to be this big" and "I can't cover this tube", "Is my eye going to stay this way?"
Goals / Outcomes (Risk of Infection)
Remain free of infection during hospital stay
Describe signs and symptoms of infection
Demonstrate appropriate care of incision, staples, and j/p drain (including hand washing, use of gloves, and proper washing of incision and surrounding hair)
Nursing Interventions (Risk for Infection)
Administer antibiotics as prescribed during hospital stay.
Teach patient on signs and symptoms of infection and when to report them.
Teach good hand washing. Teach proper incision care. How to clean J/P site.
Goals / Outcomes (Impaired Skin Integrity)
Demonstrate understanding of Plan of Care to heal incision and surrounding tissue
Regain integrity of skin and prevent re-injury
Describe measure to protect and heal skin and care for incision site
Interventions (
Impaired skin integrity
Inspect incision at Q shift for REEDA
Teach patient how to care for incision and j/p drain
Monitor and re-teach if necessary after evaluating patient's incision care practices
Goals / Outcomes
Utilize strategies to enhance appearance
Disturbed Body Image
Demonstrates social involvement
Touch and observe affected body part
Interventions (
Disturbed Body Image
Use cognitive behavior therapy to assist patient to express emotions.
Provide patient with a list of appropriate community resources for counseling.
Take cues regarding readiness to look at wound and teach to administer self care.
Use positive re-enforcement for appropriate behaviors.
Discharge Teaching
Rick Sanchez
Full transcript