Autologous Bone Cranioplasty Safety and Efficacy: A Review of 128 cases over 39 years
Nirmal Nathan, M.D., Ian Macarthur, M.D., Ryan Burke, B.S., Stephen Anthony Wolfe, M.D..
Miami Children's Hospital, Miami, FL, USA.
Introduction: Many cranioplasties in the U.S. are performed with alloplastic implants because of ease of the procedure and a lack of experience related to bone harvest. Published series of alloplastic repairs have reported infection rates of 9 to 23%.
The senior author has used autogenous bone of various sources for 128 calvarial defects over a 39-year period and this report will present that experience.
Methods: A total of 134 cases met inclusion criteria (several patients had staged reconstructions). Data regarding patient demographics, underlying pathology, complications, and length of follow-up were collected.
Results: Average patient age was 22, with a range of 12 months to 76 years. Causes of the cranial defects included trauma, malignancy, infection, craniosynostosis, and surgically created defects resulting from full-thickness calvarial harvest. Donor sites included calvarium (72%), rib (22%) and ilium (10 %). Eleven patients had had prior failures with alloplastic materials.
Notably, there were no cases of infection, no cases requiring bone graft removal, and no significant graft resorption on follow-up. Furthermore, no complications were seen related to harvesting of the autogenous grafts.
Conclusions: This retrospective study demonstrates that autogenous bone is the ideal graft replacement for full-thickness, cranial vault defects. Absolute indications for the use of autogenous bone include defects near the paranasal sinuses, defects in growing children, previous alloplastic failures, and complex orbito-cranial defects requiring staged procedures. More emphasis should be placed on teaching plastic surgery residents how to harvest and work with bone so that alloplastic materials will not be their only recourse.
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