Cranioplasty with Neovascularized Autogenous Calvarial Bone

Abstract

We have presented two cases of cranioplasty with neovascularized autogenous calvarial bone. A surgical procedure applying the principle of flap prefabrication has been applied to the preservation of autogenous calvarial bone obtained during external cranial decompression. The rectus abdominis muscle flap was elevated. A subcutaneous pocket was prepared for preservation of calvarial bone integrated with the rectus abdominis muscle. The outer cortex of calvarial bone was removed partially by bone chiseling. The muscle flap was attached to the bone graft by means of two holes on the bone by suture. The calvarial bone, grafted onto the rectus abdominis muscle flap, was inserted into the subcutaneous pocket. Several weeks later, the neovascularized calvarial bone flap was dissected along with inferior epigastric pedicle. Cranioplasty was performed using the bone element of the flap. Revascularization was achieved by anastomosing the inferior epigastric vessels to the temporal vessels. The postoperative films demonstrated marked radiolucency at the borders of the flap, although bone scan documented that the flap was vascularized. We speculate that the transferred bony segment was not completely vascularized.

A treatment algorithm for patients with large skull bone defects and first results

“…Resorptive processes of various degrees are unavoidable in all the clinical procedures mentioned (Li et al, 2005). From the biological standpoint the reintegrated skull bone is an osteoconductive, nonperfused implant that will be remodelled by the surrounding tissues (Tsukagoshi et al, 1998). Remodelling is a process, which can lead to full resorption of the autogenous bone material.…”

Bone flap storage following craniectomy: a survey of practices in major Australian Neurosurgical centres

“…Historically, the concept of skull flap cryopreservation has been present for at least six decades 3 . Intuitively, the use of autogenous bone flap for delayed cranioplasty represents a logical choice, offering a biological and exact reconstruction of the skull defect with the potential for engraftment, remodelling and growth 9 . Furthermore, the additional costs of alloplastic substitutes and risks of foreign body reaction/rejection are avoided.…”

Prefabricated Galeal Flap Based on Superficial Temporal and Posterior Auricular Vessels

“…[45][46][47][48][49] Çelik et al 45 observed that prefabricated bone showed histological characteristics similar to those seen in normal bone after 12 months in rabbits. In a histological study of bone prefabrication using a rat model, Gill et al 46 observed that the original bone was dead but extensive new bone formation was visible 3 weeks after implantation, whereas newly formed bone had progressed after 6 weeks.…”

“…47,48 Tsukagoshi et al 47 sutured the cranial bone graft onto the rectus abdominis muscle and transferred the integrated bonemuscle complex to the cranium using a microsurgical technique after a delay period. We prefabricated the cranial bone inside the adjacent tissue and prepared a local flap during the subsequent operation.…”