Cranioplasty in children.
OBJECTIVE
The objective was to assess the outcome and complications associated with different cranioplasty implant materials in children.


METHODS
A retrospective review was conducted of 28 consecutive cranioplasties carried out on 24 children between 1994 and 2001 (age range, 9 months to 15 years; minimum follow-up 18 months). The indications were: defect from previous craniectomy for trauma, tumour, infection or evacuation of haematoma (n=21), intradiploic dermoid cysts (n=2), growing fractures (n=4) and residual bony defect following craniofacial reconstruction (n=1). The materials used were: patient's craniectomised bone flap (n=16), split calvarial graft (n=8), acrylic (n=3) and titanium (n=1). All patients were assessed for bony fixation, cosmesis, wound healing and flap infection.


RESULTS
There was no mortality and 18% morbidity (n=5: 3 infected flaps, 1 sterile wound dehiscence and 1 sterile wound discharge; overall infection rate 10%). Out of the 14 patients who had their own craniectomised bone flaps implanted initially, 3 became infected (2 in patients with bilateral defects) necessitating flap removal. Two of these were successfully re-implanted. No donor or recipient bone flap complications were seen in the 8 split calvarial grafts, wound discharge was seen in 1, requiring wound toilet. No complications were seen with acrylic or titanium cranioplasties.


CONCLUSIONS
In this series, the use of the patients' own craniectomised flap had a low infection rate, and was mainly seen in patients who had bilateral flaps re-implanted soon after removal. There were no complications arising from the use of split calvarial and allograft material. Use of autologous implant material should be preferred whenever possible due to obvious resource and biological advantages, and can even be re-implanted if infected.
Josan
V A
VA
Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
Sgouros
S
S
Walsh
A R
AR
Dover
M S
MS
Nishikawa
H
H
Hockley
A D
AD
D000293:Adolescent; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation; D001927:Brain Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014025:Titanium / Q000627:therapeutic use; D016896:Treatment Outcome
D018786:Bone Substitutes; D014025:Titanium