American Association of Plastic Surgeons

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The Fate Of The Frozen Bone Flap: Quantitative Assessment Of Bone Flap Resorption Following Delayed Autologous Cranioplasty
Sai Cherukuri, MBBS, Eugene Zheng, MD, Andrew Emanuels, MD, Jamie Van Gompel, MD, Jonathan Morris, MD, Uldis Bite, MD, Samir Mardini, MD, Waleed Gibreel, MBBS;
Mayo Clinic Rochester, Rochester, MN, USA

Introduction: Bone flap resorption following cranioplasty with frozen, autologous bone flap is poorly defined. We sought to assess bone flaps within this context to delineate the degree and timeframe of resorption. Methods: Patients who had craniectomy and cranioplasty with stored bone flap between 2012 and 2022 were reviewed. Patients without sufficient radiographic imaging data were excluded. CT scans underwent volume analysis using Mimics Innovation Suite (Materialise, Leuven, Belgium). Results: 44 patients (68% male) met inclusion criteria. Median follow-up duration was 16.6 months (range 3.4-85.4 months). Cranioplasty occurred at a median time of 40 days (range 8-266 days) following craniectomy. Radiographically-detectable bone resorption occurred in 27 patients (61%). These patients had a mean volume decrease of 31.4% at 12 months following cranioplasty. Seven patients had clinically-significant bone flap resorption requiring revision alloplastic cranioplasty at median time of 9.2 months. Their mean bone flap retention at the time of revision cranioplasty was 25.7%. In comparing patients with resorption to patients without resorption, there was no statistically significant difference in mean age [36.4 vs 45 years], mean days to cranioplasty [72.3 vs 43.2 days], mean volume of cranioplasty bone flap [62.2 cm3 vs 48.7 cm3], median follow up duration [22.6 vs 36.2 months], or comorbidities. Conclusion: Frozen bone flaps undergo variable degrees of resorption in the following delayed cranioplasty. Clinically-significant bone flap resorption requiring alloplastic cranioplasty tends to develop in the first 10 months from surgery. Hence, regular clinical follow up in the first year is necessary to identify this subset of patients.
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