Debunking a Surgical Myth: Split Cranial Bone Grafting in Children Less Than 3 Years of Age
Christian J. Vercler, MD, Kristoffer B. Sugg, MD, Steven R. Buchman, MD.
University of Michigan, Ann Arbor, MI, USA.
In cranioplasty patients, split cranial bone provides excellent structural support and fundamentally "replaces like with like.” It is easily contoured making it ideal for cranial vault remodeling. However, traditional teaching in craniofacial surgery is that cranial bone cannot be split before the age of three due to the absence of the diploic space. Interestingly, we have found this not be the case, and herein describe our experience with splitting cranial bone in children with craniosynostosis less than three years of age.
A retrospective review of 418 cranioplasties performed between 1997 and 2013 by a single surgeon, was completed on patients less than three years of age with both syndromic and non-syndromic craniosynostosis. The average age of the reviewed patients at the time of the procedure was 328 days. The youngest patient was 58 days.
Of the 418 cranial procedures performed in this study cranial bone was able to be split and used as bone graft in every case. Although the presence of Lückenschadel prevented a complete split of the inner table from the outer table of the bone flap, split cranial bone graft was still able to be performed providing significant grafting material to foster reconstruction. Thirteen patients (3.1%) required revisional bone grafting for persistent cranial defect. No complications from split cranial harvest were observed.
Contrary to popular belief and the misconception perpetuated by the Plastic Surgery In-Service Examination, the cranium of children under the age of three can indeed be safely and predictably split between the inner and outer cortex. This important finding provides the craniofacial surgeon with a valuable, expanded, source of rigid bone available for cranial vault remodeling in the pediatric patient population
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