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Avoiding Demineralized Bone Matrix and Resorbable Mesh Bilaminate Cranioplasty in Pediatric Large Calvarial Defects Over Scarred Dura
Lucas Dvoracek, Jonathan Lee, Joseph Losee, Jesse Goldstein
University of Pittsburgh
2017-02-15
Presenter: Lucas Dvoracek
Affidavit:
This project is original and the majority of the work was completed by the resident with assistance from associated authors.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Replacement of the autologous bone flap after decompressive craniectomy can be complicated by significant osteolysis or infection with large defects over scarred dura. Demineralized bone matrix (DBM) is an alternative to autologous reconstruction, effective when reconstructing large defects using a resorbable mesh bilaminate technique in craniosynostosis cranioplasty, but this technique has not been studied in the setting of post-decompressive craniectomy scarred dura.
Retrospective review was performed of patients receiving DBM and resorbable mesh bilaminate cranioplasty for post-decompressive craniectomy defects. Seven patients (mean age 5 years) were identified with mean follow up of 36.1 months. Computed tomography before the DBM cranioplasty and at least one year postoperative were compared. Volume and area of ossification of the defect and need for revision were assessed.
All patients had hemispheric craniectomy and duraplasty with associated hemi-dural scarring. Five patients had autologous bone flap cranioplasty associated with near-total osteolysis prior to DBM cranioplasty, while two patients had deferral of bone flap. DBM cranioplasty demonstrated unpredictable and poor ossification with coverage and volume of bone within the defect increased by 0.9% (range -3.7% to 10.8%) and 1.4% (range -57% to 57%) respectively. All patients required major revision cranioplasty at mean time 30.3 months. Porous polyethylene was utilized in six of the revisions while split calvarial and particulate bone graft was used in the remaining patient, with mean follow up of 5.4 months.
Although using DBM with resorbable mesh bilaminate is appropriate in craniosynostosis cranioplasty, it should be avoided in the setting of scarred or infected dura.
