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J Craniofac Surg. 2011 Sep;22(5):1584-90. doi: 10.1097/SCS.0b013e31822e5dc5.

Purse-string closure for frontoethmoidal encephalomeningocele.

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Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.



Skin incision over the nose is routinely made for accessing the nasal structures, removing the mass, as well as resecting the redundant skin in patients with frontoethmoidal encephalomeningocele (FEEM). Unfortunately, the conventional elliptical excision leaves a long, straight-line scar that becomes a stigma of the disease.


The author describes a purse-string closure technique for closure of the skin defect over the nasal dorsum in a patient with FEEM, which results in the reduction of a surgical scar.


The skin overlying the encephalocele is pinched and marked around the mass. The skin is cut, and the encephalocele is dissected deep down the bony opening. Then a bicoronal scalp flap and frontal craniotomy and bilateral medial orbital walls osteotomies are performed. The encephalocele is removed at the neck, and the dural defect is repaired. The bony defect is repaired and bone-grafted as necessary. The skin defect is closed with double layers with the purse-string closure technique and crisscross mattress sutures.


: Between January 2004 and July 2009, a total of 7 FEEM patients underwent a 1-stage combined intracranial and extracranial repair and reconstruction of the deformity using the purse-string closure technique.


The purse-string closure technique as described provides an alternative skin closure for the repair and reconstruction of FEEM.

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