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Long-term Effect Of Cranioplasty On Scalp Atrophy
Grzegorz Kwiecien MD, Nicholas Sinclair MD, David Mihal MD, James Zins MD.
Cleveland Clinic
2019-02-15
Presenter: Grzegorz Kwiecien
Affidavit:
The above referenced material represents original work of the resident
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
INTRODUCTION
Anecdotal reports have documented thinning of soft-tissue cover over certain alloplastic cranioplasties. This can lead to complex wound problems. However, the details of this process remain unknown. The aim of this study was to describe long-term soft-tissue changes over various cranioplasty materials and to examine risk factors for accelerated scalp thinning.
METHODS
A retrospective review of patients treated with isolated cranioplasty between 2009 and 2013 was conducted. To limit confounders, patients with additional scalp reconstruction or radiologic follow-up shorter than one year were excluded. Computed tomography or magnetic resonance imaging was used to measure scalp thickness in identical locations over cranioplasty and on the mirror image sides at different time points.
RESULTS
Ninety-four patients treated with autologous bone (n=34), polymethylmethacrylate (n=30), and titanium mesh (n=30) were identified. Mean skull defect size was 82.3±48.2cm2. Mean length of follow-up was 5.9±2.3years. Significant thinning of the scalp occurred over all materials including non-vascularized autologous bone flaps (p<0.05). This was most notable over the first two years after reconstruction. Risk factors included radiation (p<0.05), reconstruction in temporal location (p<0.05), and T-shape or "question mark" incision (p<0.05). After matching for all risk factors, cranioplasty material was not a significant predictor (ANOVA; p=0.126).
CONCLUSION
Thinning of the scalp occurs over all non-vascularized cranioplasty materials and autologous bone is not immune to this process. Scalp atrophy is most evident in the first two years after reconstruction. Radiation, temporal location, and exposure with T-shape or "question mark" scalp flaps play a role in accelerated soft-tissue thinning.
