Management of Skull Fractures and Calvarial Defects

Abstract

Scalp and calvarial defects can result from a myriad of causes including but not limited to trauma, infection, congenital malformations, neoplasm, and surgical management of tumors or other pathologies. While some small, nondisplaced fractures with minimal overlying skin injury can be managed conservatively, more extensive wounds will need surgical repair and closure. There are many autologous and alloplastic materials to aid in dural and calvarial reconstruction, but no ideal reconstructive method has yet emerged. Different reconstructive materials and methods are associated with different advantages, disadvantages, and complications that reconstructive surgeons should be aware of. Herein, we discuss different methods and materials for the surgical reconstruction of calvarial defects.

ADSC-Based Cell Therapies for Musculoskeletal Disorders: A Review of Recent Clinical Trials

“…Although the use of autografts is considered to be the gold standard for the reconstruction of bony defects [77,78], they still have limitations such as donor site morbidity, bone resorption, and lack of tissue availability [79][80][81]. On the other hand, alloplastic grafts have no donor-site morbidity and can be precisely shaped for individualized reconstruction so that they have replaced autografts as the more advanced gold standard for the reconstruction [82]. Nevertheless, they also have limitations such as a lack of ability to integrate and grow with the host bone [83,84].…”

Biomechanical Study on the Comparison of Synthetic Materials for Cranio-Orbital Fracture Repair

“…Although autologous reconstruction has been the gold standard for repairing skull defects, 16 it is difficult to completely repair the larger defects and to recover the natural contours and curves of the craniomaxillofacial surface, which may result in poor cosmetic repair. 5 Therefore, when repairing and reconstructing a certain area of cranio-orbital defects, it is necessary to replace them with suitable implants to restore their anatomy and function. 17 Park et al 18 stated that cranial implants should fit the size of the cranial defect and need to fill the gap between the implant and the bone.…”

“…In this case, the cranio-orbital defect was >2×3 cm, as measured on computed tomography (CT) images. The fracture involved the frontal and orbital bones, and the area of the defect met the criteria for requiring material repair 5 …”

“…The fracture involved the frontal and orbital bones, and the area of the defect met the criteria for requiring material repair. 5 Besides, the patient received intraoperative fixation with titanium material and after a year of postoperative follow-up, the patient's appearance and function had recovered well. Preoperative CT images of the patient's craniomaxillofacial (64-row spiral CT, scanning layer thickness is 0.64 mm) were obtained and saved in DICOM format.…”