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Outcomes in Reconstruction of Complex Scalp and Calvarial Defects – Revisiting the Role of Titanium Mesh Cranioplasty in High Risk Patients
Grzegorz J. Kwiecien, MD; Steven Rueda, MD; Rafael A. Couto, MD; Ahmed Hashem, MD; Sean Nagel, MD; Graham S. Schwarz, MD; James E. Zins, MD, Brian R. Gastman, MD
Cleveland Clinic
2018-02-15
Presenter: Grzegorz Kwiecien
Affidavit:
The resident was involved in all aspects of this project completion. More than 50% of this work was done by the resident.
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND:
Titanium mesh is a popular material for cranioplasties. However, long-term outcomes of these reconstructions remain unknown. We aimed to compare long-term outcomes between patients undergoing both 1) skull reconstruction with titanium mesh and other commonly used cranioplasty materials, and 2) scalp reconstructions with locoregional flaps and free tissue transfers.
METHODS:
A retrospective review of patients treated with 466 cranioplasties between 2002 and 2014 was performed.
RESULTS:
Materials used for reconstructions included non-titanium alloplast (52.0%), titanium mesh (38%), and autologous bone (10%). Median cranial defect size was 58.4cm2. Eighty-three reconstructions (18%) included full-thickness scalp defect with a median area of 155.4cm2. Median follow-up was 3.9 years. Success rate for isolated cranioplasty was 90%, 89.9%, 77.1% for titanium mesh, non-titanium alloplast, and autologous bone, respectively (p>0.05). In composite defect cases, success rate for autologous bone was comparable: 81.8% (p>0.05) whereas for titanium mesh and non-titanium alloplast was significantly lower: 46.8% and 72.0% respectively (p<0.05). The success rate of titanium mesh cranioplasty with free fascio- and myocutaneous flaps was higher when compared to locoregional and free muscle flaps (p<0.05).
CONCLUSIONS:
Titanium mesh offers a durable repair of isolated bone defects. However, in high-risk patients with soft-tissue defect the outcomes are significantly worse. In these cases, free tissue transfer for soft-tissue coverage tends to be more successful, especially when using a myocutaneous or fasciocutaneous free flap. Titanium mesh combined with a locoregional scalp flap or free muscle flap has a high complication rate. Therefore, it should be used with caution.
