title: Hydroxyapatite cement in pediatric craniofacial reconstruction.
abstract: The gold standard for closing small cranial defects is autogenous bone: iliac crest, rib, or split calvarial grafts. Autogenous grafts result in donor site morbidity, increased operative time, blood loss, and additional cost, and they are limited in quantity. Hydroxyapatite cements are alternative bone substitutes that eliminate these restrictions. Although the use of hydroxyapatite is well accepted in completely developed crania, its use in the growing pediatric skull is limited. The purpose of the current study was to address the safety and long-term efficacy of this bone substitute for the repair of craniofacial bone defects in the growing pediatric skull. Safety is measured dually by resistance of bone substitute to infection and its tolerability by lack of a foreign body reaction. Efficacy is evaluated as structural skull integrity, volume stability with time, aesthetic quality, and most importantly, the ability to integrate adequately into a growing cranium without subsequent deformity or complications. This is a retrospective review of all pediatric patients at the authors' institution who underwent reconstruction of cranial defects using hydroxyapatite cement between May 1997 and March 2001. Eight patients who underwent 11 operations between the ages of 25 and 100 months (mean, 55 months) were followed up between 23 and 72 months (mean, 38 months). No mortalities or significant morbidities were encountered in the study population. It has been the authors' experience that hydroxyapatite cement is both biocompatible and resistant to infection when used in sites not contiguous with sinus mucosa; and that it is a good alternative to autogenous bone in pediatric craniofacial reconstruction.
authors.affiliation: Department of Plastic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston Salem, NC 27157-1075, USA. ldavid@wfubmc.edu
authors.forename: Lisa
authors.initials: L
authors.lastname: David
authors.forename: Louis
authors.initials: L
authors.lastname: Argenta
authors.forename: David
authors.initials: D
authors.lastname: Fisher
mesh_terms: D001672:Biocompatible Materials / Q000627:therapeutic use; D018786:Bone Substitutes / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003394:Craniofacial Dysostosis / Q000601:surgery; D003398:Craniosynostoses / Q000601:surgery; D005147:Facial Bones / Q000254:growth & development / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005549:Foreign-Body Reaction / Q000517:prevention & control; D006801:Humans; D006882:Hydroxyapatites / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012449:Safety; D012886:Skull / Q000254:growth & development / Q000601:surgery*; D013530:Surgical Wound Infection / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; D018786:Bone Substitutes; D006882:Hydroxyapatites; C475044:hydroxyapatite cement