Sinking skin flap syndrome (or Syndrome of the trephined): A review

Background: Bone defects of the skull are observed in various pathological conditions, including head trauma and conditions requiring surgery of the skull. Independent of the consequences of the original aetiology that necessitated the craniectomy, the bone defect alone may be the cause of the symptoms, called 'trephined syndrome' or 'sinking skin flap syndrome'. Despite the early recognition of neurological symptoms directly linked to craniectomy, the description of this syndrome has often relied on a small series or single clinical case reports.

Objectives: To list the previously reported symptoms of SSFS.

Data sources: We selected the references for this review by searching PubMed, focusing on articles published prior to June 2013 and using references from relevant articles.

Study eligibility criteria: We used the following search terms: 'trephined syndrome', 'syndrome of the trephined', 'Sinking skin flap', and 'sinking skin flap syndrome'. There were no language restrictions. The final reference list was generated on the basis of its relevance to the topics covered in this review.

Conclusions: Clinicians need to be aware of sinking skin flap syndrome and to look for abnormal neurological developments in patients with craniectomy in order to avoid unnecessary testing and to prevent its occurrence. Accordingly, cranioplasty can be undertaken as soon as necessary.