Sunken flap following chest tube placement in the presence of ventriculopleural shunt: a case report.

Stephanie Q Liang, Fawaz Philip Tarzi, Gene Y Sung, Roy A Poblete

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Article in Journal of medical case reports, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed

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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

Hemiplegia and sinking flap syndrome within 2 hours of decompressive craniectomy: A rare case following intraoperative cardiac arrest.Surgical neurology international · 2025
Article

4 · The record

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5 · Who and what money

Authors and funding

4 authors.

Stephanie Q LiangDepartment of Neurology, Los Angeles General Medical Center/University of Southern California, 1100 N. State St., Clinic Tower A4E, Los Angeles, CA, 90034, USA. Stephanie.Liang@med.usc.edu.ORCID http://orcid.org/0000-0001-9725-0986

Fawaz Philip TarziDepartment of Neurology, Los Angeles General Medical Center/University of Southern California, 1100 N. State St., Clinic Tower A4E, Los Angeles, CA, 90034, USA.

Gene Y SungDepartment of Neurology, Los Angeles General Medical Center/University of Southern California, 1100 N. State St., Clinic Tower A4E, Los Angeles, CA, 90034, USA.

Roy A PobleteDepartment of Neurology, Los Angeles General Medical Center/University of Southern California, 1100 N. State St., Clinic Tower A4E, Los Angeles, CA, 90034, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe sunken flap or sinking skin flap syndrome is a complication that can be observed following decompressive craniectomy. More rare, sinking skin flap syndrome can occur as an iatrogenic complication of pleural effusion evacuation via chest tube placement in the presence of ventriculopleural shunt. CASE PRESENTATION: We report the case of a Hispanic male patient in his 20s who presented to the emergency department after sustaining a penetrating gunshot wound to the head. In addition to undergoing an emergent decompressive craniectomy, a ventriculopleural shunt was subsequently placed as a treatment for hydrocephalus. Two days after shunt placement, the patient developed significant hydropneumothorax that did not respond to observational management. Owing to the severity of his hydropneumothorax, a chest tube was placed for evacuation, but he developed a sinking skin flap at the craniectomy site. The suction function of the chest tube was discontinued, and the ventriculopleural shunt pressure was increased. Within 24 hours, the skin flap reexpanded. We hypothesize that the inherently negative pressure of the pleural space combined with significant suction effect from chest tube evacuation placed him at risk of sinking skin flap syndrome despite having an antisiphon device.

conclusionOur case highlights the importance of understanding cerebrospinal fluid hydrodynamics with shunt presence and suggests a potential treatment framework for iatrogenic sinking skin flap syndrome in the presence of ventriculopleural shunt.

Indexed as

Chest TubesDecompressive CraniectomyCerebrospinal Fluid ShuntsHumansHydrocephalusMalePleural EffusionSurgical FlapsWounds, GunshotYoung AdultCase reportChest tubeOverdrainageSinking skin flapVentriculopleural shunt

Identifiers

PMID39719649

DOI10.1186/s13256-024-04963-9

PMCPMC11669209

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LicenceCC BY-NC-ND

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.