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Reconstruction of Secondary Large Calvarial Defects with Ex-Situ Split Calvarial Bone Grafts
Russell S. Frautschi, Grzegorz Kwiecien, Brianna Halasa, Antonio Rampazzo, Jillian Krebs, Frank Papay, James E. Zins, Bahar Bassiri Gharb
Case Western Reserve University School of Medicine; Cleveland Clinic
2017-02-20
Presenter: Russell Frautschi
Affidavit:
This abstract represents original work which Russell Frautschi has contributed significantly to, specifically in data collection, interpretation, and manuscript writing.
Director Name: Bahar Bassiri Gharb
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background:
Reconstruction of secondary calvarial defects continues to represent a challenge. Autologous reconstruction presents the advantages of biocompatibility, biointegration, and growth potential at the expense of donor site morbidity and possible resorption. We investigated the outcomes of skull reconstruction with split calvarial bone graft (SCBG), analyzing risk factors for poor outcomes and changes in graft thickness.
Methods:
A retrospective chart review of patients who underwent cranioplasty with SCBG between 1982 and 2016 was performed. Complications were divided into minor and major based on admission and requirement for reoperation. Changes in graft thickness were analyzed using follow-up CT and MRI scans.
Results:
Forty patients with an average age of 33.2 years, cranial defect size 68cm2, mean follow-up of 27.6 months were included. The majority of patients (85%) had significant comorbidities or risk factors. Minor or major complications occurred in 37.5% of the cases, with the most common being resorption (18%), followed by irregularities (13%), and infection (5%). Patients with ≥1 comorbidity (OR=2.12; p=0.04) were more likely to experience a complication. Prior infection did not increase the likelihood of complication (p=0.80). Mean radiographic follow-up was 11.9±10.9 years. Within the first year after SCBG, the mean ratio of the recipient-graft to the original donor bone thickness was 0.47±0.11 and 0.52±0.04 for the donor site. These ratios remained stable throughout follow-up at 0.48±0.17 and 0.57±0.10, respectively (p>0.05).
Conclusions:
Skull reconstruction with SCBG in the setting of significant comorbidities and risk factors yields a high first-attempt success rate (72%), with good longevity, biocompatibility, and biointegration.
