Autogeneic Skull Bone Grafts to Reconstruct Large or Complex Skull Defects in Children and Adolescents

Edwards, Michael S. B.; Ousterhout, Douglas K.

doi:10.1227/00006123-198702000-00013

Cited by 80 publications

(27 citation statements)

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“…Reimplantation of the patient's own bone flap yields excellent cosmetic results with a short operation time, as no modelling is required prior to the replacement. Some authors claim that this method is superior to the use of alloplastic materials [11,36]. When the autogenic bone flap is not available for whatever reason, allogenic frozen bone draft can be used instead.…”

Section: Introductionmentioning

confidence: 99%

Use of frozen cranial vault bone allografts in the repair of extensive cranial bone defects

et al. 1997

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In cranioplasty complexity is proportional to the size of the detect, particularly if greater than 50 cm2. If the patient's own bone flap is not available, allogenic frozen bone graft can be used instead. Between June 1990 and June 1995 twenty cranioplasties with allogenic frozen bone grafts were performed. Age of patients ranged between 23 and 63 years (average 38.4 years). Male/female ratio was 2:1.7. Size of craniectomy ranged between 65 and 150 cm2 (average 83.3 cm2). Follow-up ranged between 10 and 58 months (average 41 months). Donors were tested to rule out transmissible diseases, infections, sepsis and/or cancer. Bone grafts were removed under aseptic conditions, microbiological cultures were taken, wrapped in a gauze soaked with Gentamicin sulphate and Bacitracin, sealed in three sterilised vinyl plastic bags, and stored in a deep freezer for a minimum of 30 days (range 36-93 days, average 67 days), at a temperature of -80 degrees C. Grafts were placed in the defect after a step was carved on its borders to facilitate the contact between host and graft. Vancomycin 1 g. IV/12 hours and Ceftriaxone 1 g. IV/12 hours were administered for five days. Grafts were covered by means of scalp flaps. Only one required a musculocutaneous free flap. None was exposed, extruded or had to be removed. Plain skull X-ray studies showed progressive remodelling of the grafts. Partial resorption was observed in two (2/20, 10%) and loss of thickness in another 3/20 (15%), but with no changes in the contour. Biopsies were taken in 3/20 (15%) cases at a second surgical procedure. Areas of osteoclastic resorptive activity mixed with others of osteoblastic bone apposition, showed replacement with new bone. We conclude that cranial vault frozen allografts are a good alternative to autologous bone when the latter is absent or not present in sufficient amount.

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Section: Introductionmentioning

confidence: 99%

Use of frozen cranial vault bone allografts in the repair of extensive cranial bone defects

et al. 1997

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“…However, further recommendations vary among authors. Edwards & Ousterhout (1987) recommend that the graft should be taken from the medial and posterior thirds of the parietal, which correspond to Sm and Sp in the present study. On the other hand, Sullivan & Smith (1989) and Kohan et al (1989) recommend that harvesting should be carried out in the anterior third (Sa), 2 cm away from the coronal suture and 1,5 cm away from the sagittal suture.…”

Section: Discussionmentioning

confidence: 97%

Potential Donor Sites of the Parietal for Bone Grafting and its Relationship to the Cephalic Index

2017

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M. Potential donor sites of the parietal for bone grafting and its relationship to the cephalic index. Int. J. Morphol., 35(3):986-991, 2017. SUMMARY:The purpose of the present study was to chart the thickness of the parietal bone and establish its relationship with the cephalic index and sex aiming at improving current knowledge and guidance for obtaining calvarial bone auto-graft material. Both left and right parietal bones of 150 skulls of adult human cadavers classified as either dolicho-, meso-, or brachicephalic, and as either male or female had their thickness measured at 3 levels -superior (S), middle (M) and inferior (I) -and at 3 points -anterior (a), middle (m) and posterior (p) -in each level, all evenly laid out. No relevant differences in thickness whether comparing sex or cephalic index was evidenced. The thickest measurements were found at points located at superior and middle levels in middle and posterior positioning -Sm, Sp, Mm and Mp -with median values ranging from about 5.5mm to 7.13mm. At inferior level and posterior positioning, thickness median values ranged from 4.71 to 5.84mm. Safer harvesting of bone graft material occurs in Sm, Sp, Mm and Mp areas of the parietal bone. Only exceptionally should Ip domain be used, whereas Sa, Ia and Im regions should be considered non-donor sites.

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“…However, cost and availability may be prohibitive. Edwards and Ousterhout [10]reported excellent results using calvarial grafts in 19 patients, aged 1–17 years. The patient population was remarkably similar to the current series.…”

Section: Discussionmentioning

confidence: 99%

“…The graft was later removed when the patient was threatened with excommunication from the church [7]. Split calvarial grafts are a good source of autologous bone and have been used successfully for cranioplasty [8, 9], including the pediatric population [10, 11]. A drawback to this method in children less than 4 years of age is difficulty associated with thickness and availability of donor bone.…”

Section: Introductionmentioning

confidence: 99%

Successful Use of Rib Grafts for Cranioplasty in Children

Taggard

Menezes²

2001

Pediatr Neurosurg

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Numerous materials are available for use in cranioplasty including bone, plastics and metals. Rib grafts as a construct for cranial reconstruction offer several advantages: autologous bone source, a formable platform, low infection, regeneration at the donor site and high fusion rates. Criticism of rib graft cranioplasty includes scarring and pain at the donor site, irregular contour at the graft site and graft reabsorption. Since 1988, we have performed rib autograft cranioplasty on 13 patients. Seven females and 6 males combined for an average age of 6 years (11 months to 20 years) at the time of surgery. The mean follow-up from surgery is 27 months (2–48 months), with 11 subjects having at least 12 months. The commonest reasons for cranial reconstruction were: post-traumatic calvarial defect (n = 4), defect from previous craniotomy (n = 3), ‘growing’ skull fracture (n = 2), and defect from previous encephalocele closure (n = 2). Mean defect size was 41 cm² (8–144 cm²) and average number of ribs harvested was 1.75 (1–3). Simple rib cranioplasty had a mean time in the operating room of 6 h and 30 min. No donor site complications were noted (pneumothorax, significant post-operative pain) and no post-operative infections were encountered. Excellent cranial contour was achieved in each of the 11 patients followed for a minimum of 12 months. One subject required staged reconstructive procedures owing to the size of the defect.

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Autogeneic Skull Bone Grafts to Reconstruct Large or Complex Skull Defects in Children and Adolescents

Cited by 80 publications

References 0 publications

Use of frozen cranial vault bone allografts in the repair of extensive cranial bone defects

Use of frozen cranial vault bone allografts in the repair of extensive cranial bone defects

Potential Donor Sites of the Parietal for Bone Grafting and its Relationship to the Cephalic Index

Successful Use of Rib Grafts for Cranioplasty in Children

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