Improved rehabilitation efficiency after cranioplasty in patients with sunken skin flap syndrome: a case series

ABSTRACT

Purpose

Sunken Skin Flap Syndrome (SSFS) is an uncommon, delayed complication after craniectomy characterized by a functional plateau or decline with variable neurologic symptoms, improving after cranioplasty. SSFS negatively impacts the rehabilitation course, with subjective reports of functional improvement after cranioplasty. However, no studies have assessed the impact of cranioplasty on functional recovery rate. This case series aims to analyze SSFS manifestations and management while awaiting cranioplasty. Also, to assess the role of cranioplasty on rehabilitation outcomes and recovery rate in SSFS patients.

Methods

Four patients were identified with SSFS in inpatient rehabilitation. Each patient had unique clinical manifestations, with multiple strategies used for symptomatic control. Patients spent an average of 23 days in rehabilitation with SSFS symptoms before cranioplasty. After cranioplasty, all patients had SSFS symptom resolution. Comparing change in functional independence measure (FIM) scores and FIM efficiency pre-and post-cranioplasty rehabilitation course, a mean improvement of 23 and 0.72 occurred after cranioplasty, respectively.

Conclusion

A diagnosis of SSFS should be considered in craniectomy patients exhibiting functional decline or plateau with associated neurological symptoms. This study suggests that FIM and FIM efficiency increases in SSFS patients after cranioplasty, supporting prompt cranioplasty to improve functional outcomes and minimize rehabilitation delays.

KEYWORDS:

• Sunken skin flap syndrome
• syndrome of the trephined
• decompressive craniectomy
• cranioplasty
• functional independence measure (FIM) efficiency

Acknowledgments

Thank you to Arline Edmond, MD and Amy Teale, PhD for assistance in manuscript editing and formatting.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Neil Jasey

Nicole Diaz-Segarra reports no conflicts of interest. Neil Jasey reports no conflicts of interest. There were no funds or grants used for this work. There is no financial benefit to any of the authors. The work in this manuscript was presented in poster and abstract format at the Association of Academic Physiatrists Annual Meeting in 2021. The work in this manuscript is not under consideration for publication in another journal. Informed consent was obtained from the parent/legal guardian of all patients to participate in this case series.