Successful Use of Rib Grafts for Cranioplasty in Children

Abstract

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.

Outcomes of cranioplasty following decompressive craniectomy in the pediatric population

“…In the studies included in this review, a variety of materials were used to repair the cranial defect, including fresh autograft, either rib or calvaria, harvested at the time of the cranioplasty; 2,12,15,16,18 autograft that had been stored in either a freezer or at room temperature; 2,6,8,9,12,14,15 titanium; 2,12 and methyl methacrylate. 2,3,9,12,15 Most of the studies included patients who had all undergone cranioplasty with the same material, in which case comparison of different materials was not possible.…”

Cranioplasty using polymethyl methacrylate prostheses

“…[9][10][11][12][13] A range of materials can be used to repair cranial defects, including autograft bone, allograft bone, xenograft bone and bone substitues. [14][15][16][17] Fresh frozen autogenous bone grafts obtained during the initial operation are excellent for delayed cranioplasty. However, when the autogenous bone graft is unavailable, a prosthesis may be necessary.…”

Unusual cranial reconstruction following motor vehicle accident

“…During further developments, new products as different metallic materials and celluloid gained popularity at the beginning, but lasting success was not achieved because of lack of deformability and disturbing radiolucent effects [6][7][8].…”