{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:33:20Z","timestamp":1787762000749,"version":"build-2784847793"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n                    <jats:title>INTRODUCTION:<\/jats:title>\n                    <jats:p>Decompressive craniectomy is a well described treatment to salvage life in large middle cerebral artery (MCA) territory infarcts. The size of the craniectomy is limited by the size of the skin incision and very large craniectomies need large skin flaps that are prone to necrosis at the wound margins.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIAL AND METHODS:<\/jats:title>\n                    <jats:p>We describe two modifications in the skin flap that we have used in 7 patients to achieve very large bony decompressions in malignant MCA infarctions without compromising on flap vascularity. One consists of a linear extension posteriorly from the question mark or reverse question mark incision while the other is an \u201cn\u201d shaped incision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>With these modifications we achieved craniectomies of size 15.6\u201317.8 cm in the anteroposterior and 10.7\u201312 cm in vertical axis of the bone flap removed in our patients. There were no additional procedural or wound related complications in a 6-month follow up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Removal of a standard size bone flap may achieve suboptimal decompression in cases of large MCA territory infarctions. Imaginative tailoring of skin flaps helps to remove larger volumes of skull with no added procedural morbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/bc.bc_98_22","type":"journal-article","created":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T13:03:42Z","timestamp":1688130222000},"page":"116-120","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Modifying skin flaps for achieving very large decompressive craniectomies in malignant middle cerebral artery territory infarcts: A technical note"],"prefix":"10.4103","volume":"9","author":[{"given":"Shamshuddin","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Bhosle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabanita","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Department of Neuroanesthesiology, National Neurosciences Centre, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayan","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Radiology, Peerless Hospital, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasad","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,6,30]]},"reference":[{"key":"R1-20240830","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1136\/pgmj.2009.094292","article-title":"Malignant middle cerebral artery (MCA) 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Neurotrauma"},{"key":"R11-20240830","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1159\/000365864","article-title":"Surgical aspects of decompression craniectomy in malignant stroke: Review","volume":"38","author":"Zweckberger","year":"2014","journal-title":"Cerebrovasc Dis"},{"key":"R12-20240830","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/NRL.0b013e3181f4ec88","article-title":"Newly suggested surgical method of decompressive craniectomy for patients with middle cerebral artery infarction","volume":"17","author":"Chung","year":"2011","journal-title":"Neurologist"}],"container-title":["Brain 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