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. 2014 Apr;10(1):10-4.
doi: 10.13004/kjnt.2014.10.1.10. Epub 2014 Apr 30.

Resorption of Autogenous Bone Graft in Cranioplasty: Resorption and Reintegration Failure

Si Hoon Lee  1 , Chan Jong Yoo  1 , Uhn Lee  1 , Cheol Wan Park  1 , Sang Gu Lee  1 , Woo Kyung Kim  1
Affiliations

Resorption of Autogenous Bone Graft in Cranioplasty: Resorption and Reintegration Failure

Si Hoon Lee et al. Korean J Neurotrauma. 2014 Apr.

Abstract

Objective: Re-implantation of autologous skull bone has been known to be difficult because of its propensity for resorption. Moreover, the structural characteristics of the area of the defect cannot tolerate physiologic loading, which is an important factor for graft healing. This paper describes our experiences and results with cranioplasty following decompressive craniectomy using autologous bone flaps.

Methods: In an institutional review, the authors identified 18 patients (11 male and 7 female) in whom autologous cranioplasty was performed after decompressive craniectomy from January 2008 to December 2011. We examined the age, reasons for craniectomy, size of the skull defect, presence of bony resorption, and postoperative complications.

Results: Postoperative bone resorption occurred in eight cases (44.4%). Among them, two experienced symptomatic breakdown of the autologous bone graft that required a second operation to reconstruct the skull contour using porous polyethylene implant (Medpor®). The incidence of bone resorption was more common in the pediatric group and in those with large cranial defects (>120 cm(2)). No significant correlation was found with sex, reasons for craniectomy, and cryopreservation period.

Conclusion: The use of autologous bone flap for reconstruction of a skull defect after decompressive craniectomy is a quick and cost-effective method. But, the resorption rate was greater in children and in patients with large skull defects. As a result, we suggest compressive force of the tightened scalp, young age, large skull defect, the gap between bone flap and bone edge and heat sterilization of autologous bone as risk factors for bone resorption.

Keywords: Autologous transplant; Cranioplasty; Resorption.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Change in bone density. Serial CT scans taken before operation (A), after replacement of cryopreserved autologous bone (B), and after successful reintegration (C) show changes in bone density.
FIGURE 2
FIGURE 2
Follow-up Hounsfield unit scores after cranioplasty. Follow-up Hounsfield unit scores after cranioplasty. Bone resorption occurred in eight (44.4%) out of the 18 cases.
FIGURE 3
FIGURE 3
Follow-up Hounsfield unit scores after cranioplasty in pediatric patients. PED: pediatric patient.
See this image and copyright information in PMC

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