Q: Dr. Eppley, I lost my frontal, temporal, parital skull due to an accident. My surgeon used peek polymer for a skull reconstruction. I am not pleased with the sides and it feels like screws are sticking out all over and hurts. I’m not sure what to expect from such a large cranial reconstruction and if anything can be done from your point of view?
A: Regardless of the material used, large cranial reconstructions almost always will result in some amount of plate and screw palpability. This is not usually seen for many months afterwards until all the swelling has subsided and the scalp tissues have contracted down and around the implant and the plates and screws used to secure it. This because particularly so on the sides of the head where the temporal muscle thickness is lost due to atrophy and loss of attachments to create classic temporal hollowing after any type of craniotomy/replacement.
I will make the assumption that the PEEK implant has a perfect fit to the surrounding bone because it was made from a 3D CT scan. (although often there is some edge demarcation between the bone and the implant) Almost all of these type of cranial reconstructions can be aesthetically improved through plate and screw removal, bone cement to smooth over any transition areas and fat grafting to create a thicker interface between the skin and the bone for temporal augmentation.
How any of these secondary reconstructive techniques may be applied to you would require an assessment of your exact condition through an analysis of any pictures that you can send.
Dr. Barry Eppley