Use of autologous scapula for cranioplasty: cadaveric feasibility study.
BACKGROUND
Replacement sources for calvarial defects include synthetic materials, donor grafts, and autologous bones such as ribs or split-thickness calvarial cranioplasty. When these sources are not available or are inadequate, other structures or sites would be desirable. However, and to our knowledge, the scapula has not been explored as a potential source for calvarial reconstruction. Therefore, the following study was performed to verify the utility of this bone for cranioplasty.


METHODS
Six adult (mean age 71 years) cadavers (four formalin-fixed and two fresh specimens) were used in this study. In the prone position, an incision was made over the midpart of the infraspinous fossa. Soft tissues were then removed from the anterior and posterior aspects of the scapula in this region avoiding the glenohumeral articulation superiorly. Previously made cranial defects were then filled using available scapula as a bony replacement.


RESULTS
An average of 9 x 12 x 7 cm of scapula was available for harvest inferior to the glenohumeral joint. Lateral and medial borders of the scapula were found to have a mean thickness of 9 mm. No obvious injury to surrounding vessels or nerves was found using this procedure and good coverage of calvarial defects was afforded by this bony replacement.


CONCLUSIONS
Such a bony substitute as autologous scapula might be of utility when other replacements are not available or are of a limited size. Examples of such a use would include patients in whom a hemispheric bone flap is lost. Following clinical confirmation, the neurosurgeon may wish to consider the scapula as an alternative site for bone harvest for cranioplasty as this was a feasible technique in the cadaver.
Tubbs
R Shane
RS
Department of Cell Biology, University of Alabama at Birmingham, Birmingham, AL, USA. rstubbs@uab.edu
Loukas
Marios
M
Shoja
Mohammadali M
MM
Salter
Frank
F
Salter
E George
EG
Oakes
W Jerry
WJ
D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D002102:Cadaver; D006259:Craniocerebral Trauma / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012540:Scapula / Q000637:transplantation*; D012886:Skull / Q000293:injuries / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods