Surgical outcome after autologous bone chips replacement in depressed skull fractures: a single center experience

Abstract

Background Surgery for depressed skull fractures (DSFs) is always faced by multiple challenges including ideal timing, defect reconstruction and complications. Few data are available regarding the aesthetic results and patients’ satisfaction following DSFs management. Methods A prospective non-randomized study included 59 traumatic brain injury (TBI) patients surgically treated for DSFs. Depressed bone fragments were elevated and washed with diluted hydrogen peroxide for 15 min then replaced within a net made of vicryl 0 through edges of the galea. Our objective was to evaluate outcome and patients’ satisfaction of using autologous bone fragments for skull defect reconstruction. Results The mean Glasgow Coma Scale (GCS) score on admission was 14.51 ± 1.237. The mean age was 16.505 ± 12.426 years. DSFs were of compound type in 81.4% with predominance towards the parietal region 54.2%. Associated intracranial pathologies were found in 39.0% of cases. Mean time to surgery was 5.79 ± 9.982 h. Dura was found torn in 19 cases (32.2%). Postoperative complications were encountered in 5 cases (8.5%). The mean hospital stay was 3.61 ± 3.157 days. 96.6% of cases had good discharge outcome. Factors with significant impact on outcome included; admission GCS score (P < 0.001), type of associated pathology (P = 0.006), and venous sinus involvement (P = 0.003). At the end of follow up, 46 patients (82.5%) were satisfied about the aesthetic results, while 10 patients (17.5%) were not satisfied and 9 of them underwent re-surgery for late cranioplasty. Conclusions Using autologous depressed bone chips for skull defect reconstruction can be a safe and feasible surgical technique for TBI patients suffering DSFs with good aesthetic results, high patient satisfaction, decreased need for later cranioplasty and consequently low overall management cost.