Autologous bone flap cranioplasty

Autologous bone flap cranioplasty

The bone that is removed at the time of craniectomy has been preserved for future implantation. This is generally not employed in contaminated cases (penetrating trauma, infection…).

Available evidence on the safety of cranioplasty materials is limited due to a large diversity in study conduct, patients included and outcomes reported. Autologous bone grafts appear to carry a higher failure risk than allografts. Future publications concerning cranioplasties will benefit by a standardized reporting of surgical procedures, outcomes and graft materials used 1).

During the cranioplasty procedureautologous bone flaps are preferably used due to their advantages in storage, viability, costprevention of disease transmission.

Storage options

a) in a“pocket” created in the patient’s subcutaneous abdominal fat

b) in preservative(e.g.RPMI and stored in ultra low temperature freezer


It is a simple and cheep alternative to other techniques and is available to any institution that provides autoclaving sterilisation services. 2).

Inherent difficulties of bone storage and cranioplasty are neglected in the literature.

The timing of cranioplasty and method of bone flap storage are known risk factors of non-union and resorption of bone flaps

Silay et al. present a simple method of bone storage and autologous cranioplasty in a small child with severe head injury. The child underwent surgical treatment with decompressive craniectomy. A bone flap was transversally divided into two pieces and stored under the galea. Bone storage and reconstruction of the cranial vault with this surgical technique is a safe, easy and cost-effective choice excluding the surgical trauma to obtain a new subcutanous pocket for bone storage in pediatric decompressive craniectomy patients 3).

Timing

Although generally accepted concept about timing of cranioplasty using autologous bone is that early cranioplasty has more risk of infection and delayed cranioplasty has risk of non-union or resorption of bone flap.

Shin et al. observed new bone formation on all the frozen autologous bone flaps that was stored within 8 weeks. The timing of cranioplasty may showed no difference of degree of new bone formation. Not only the healing period after cranioplasty but the time interval from craniectomy to cranioplasty could affect the new bone formation 4).

Complications

Case series

Autologous bone flap cranioplasty unclassified

References

1)

van de Vijfeijken SECM, Münker TJAG, Spijker R, Karssemakers LHE, Vandertop WP, Becking AG, Ubbink DT; CranioSafe Group. Autologous bone is inferior to alloplastic cranioplasties Safety of autograft and allograft materials for cranioplasties, a systematic review. World Neurosurg. 2018 Jun 4. pii: S1878-8750(18)31147-1. doi: 10.1016/j.wneu.2018.05.193. [Epub ahead of print] Review. PubMed PMID: 29879511.
2)

Mracek J, Hommerova J, Mork J, Richtr P, Priban V. Complications of cranioplasty using a bone flap sterilised by autoclaving following decompressive craniectomy. Acta Neurochir (Wien). 2015 Jan 15. [Epub ahead of print] PubMed PMID: 25588749.
3)

Silav G, Bölükbaşı FH, Özek E, Tönge M, Önöz M, Elmacı İ. A Simple Technique for Bone Storage after Decompressive Craniectomy in Children. Pediatr Neurosurg. 2015 May 14. [Epub ahead of print] PubMed PMID: 25998533.
4)

Shin HS, Lee DW, Lee SH, Koh JS. Analyses Using Micro-CT Scans and Tissue Staining on New Bone Formation and Bone Fusion According to the Timing of Cranioplasty via Frozen Autologous Bone Flaps in Rabbits : A Preliminary Report. J Korean Neurosurg Soc. 2015 Apr;57(4):242-9. doi: 10.3340/jkns.2015.57.4.242. Epub 2015 Apr 24. PubMed PMID: 25932290; PubMed Central PMCID: PMC4414767.

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