Autogenous Bone Cranioplasty: Review of a 42-Year Experience by a Single Surgeon

Abstract

Background: Autogenous bone is frequently espoused as the gold standard material for cranioplasty procedures, yet alloplastic cranioplasty continues to persist in the search, presumably, for a simpler technique. Although short-term outcomes can be successful using foreign materials, long-term follow-up in these patients often demonstrates increased rates of failure because of exposure or late infection. Autogenous bone grafts, however, integrate and revascularize, and are thus more resistant to infection than alloplastic materials. Methods: This is a retrospective review of all patients that underwent reconstructive cranioplasty for full-thickness defects, as performed by the senior author (S.A.W.) between 1975 and 2018. All procedures were performed with autogenous bone. Results: One hundred fifty-four patients met criteria for inclusion in the report. Cranioplasties were performed for both congenital and secondary indications. Split calvaria was used in 115 patients (74.7 percent), rib graft was used in 12 patients (7.8 percent), iliac crest graft was used in 10 patients (6.5 percent), and combinations of donor-site grafts were used in 17 patients (11.0 percent). In the entire series, none of the patients suffered from complications related to infection of either the donor site or transferred bone graft. None of the patients required secondary operations to fill in defects created by the postoperative resorption. Conclusions: Although autologous bone is widely considered the gold standard material for cranioplasty procedures, some argue against its use, mainly citing unpredictable resorption as the purported disadvantage. However, it is less susceptible to infection, and results in fewer long-term complications than alloplastic materials. There is no alloplastic material that has matched these outcomes, and thus autogenous bone should be considered as the primary option for cranioplasty procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Foreign Body Reaction Following Use of a Novel Bone Graft Substitute in Pediatric Cranioplasty

“…T otal scalp avulsions are significant injuries, most commonly secondary to long hair trapped in high-speed rotary machines. 1,3 Although variability in avulsion pattern exists, the avulsed plane is typically the loose areolar layer of the scalp. 1,2 Reconstruction of total scalp avulsion defects can be both complex and complicated.…”

“…Autogenous bone grafts, most commonly from adjacent areas of the cranium, the ribs, or the iliac crests, have several advantages including high growth potential and low infection rates. 1 However, donor site morbidity, especially in young children with few viable donor sites, is a major disadvantage. As a result, synthetic materials, such as polymethyl methacrylate or polyetheretherketone, have become the preferred option for many surgeons.…”

Current Concepts in Cranial Reconstruction: Review of Alloplastic Materials

“…Cranioplasty with autologous bone can be accomplished with either split grafts harvested at the time of reconstruction or replacement of the preserved craniectomy bone. Cabbad et al 9 recently reported a series of 153 cranioplasties accomplished with fresh split grafts. The outcomes reported, spanning four decades, are remarkable with zero complications.…”

Desktop-Stereolithography 3D Printing of a Polyporous Extracellular Matrix Bioink for Bone Defect Regeneration

“…High-energy injuries or pathological fractures, such as tumors and inflammation, are the main reasons for bone defects, which create numerous challenges in the clinical setting and require bone grafting (Campana et al, 2014;Hwang et al, 2017;Zhang H. et al, 2019). As the gold standard for bone substitution in clinical surgeries, the autogenous bone grafts application is limited by the inadequate practicability, donor-site morbidity, and complicated surgical procedures (Sharif et al, 2016;Bez et al, 2018;Cabbad et al, 2019;Chen et al, 2019). Consequently, a more valid alternative procedure of BTE platform was proposed.…”