title: Pediatric cranioplasty using particulate calvarial bone graft.
abstract: BACKGROUND
  Closure of calvarial defects in children is problematic because the supply of autologous bone is limited and alloplastic materials are not advocated. The authors previously showed that cranial particulate bone graft applied over the coronal gap during primary fronto-orbital advancement reduced the incidence of residual osseous defects. The purpose of this study was to determine the effectiveness of particulate bone graft for established calvarial defects.
  
  
  METHODS
  The authors analyzed consecutive children who had undergone cranioplasty with inlay particulate bone grafting between 1989 and 2007. Particulate bone was harvested from parietal calvaria or from the endocortex of the cranial elements using a hand-driven brace and bit. Patient records were reviewed for age at the time of cranioplasty, operative indication, size of defect, and length of follow-up. Outcome variables included persistent osseous defects, need for further cranioplasty, and complications.
  
  
  RESULTS
  Thirty-eight children had inlay particulate bone grafting at an average age of 8.0 years (range, 3 to 20 years). The average defect size was 66.5 cm (range, 5 to 250 cm). Indications for inlay grafting were revision fronto-orbital advancement, bony gaps following primary cranial remodeling, congenital defects, trauma, and tumor. Mean follow-up was 6.1 years (range, 0.5 to 18 years). Three patients (7.9 percent) had small persistent osseous defects, and one (2.6 percent) required another cranioplasty.
  
  
  CONCLUSIONS
  Inlay autologous cranial particulate bone graft effectively heals established cranial defects in children. Particulate bone graft can be harvested in infants and young children, does not require neurosurgical assistance, and has minimal morbidity.
authors.affiliation: Boston, Mass. From the Craniofacial Centre and the Department of Plastic Surgery, Children's Hospital Boston, Harvard Medical School.
authors.forename: Arin K
authors.initials: AK
authors.lastname: Greene
authors.forename: John B
authors.initials: JB
authors.lastname: Mulliken
authors.forename: Mark R
authors.initials: MR
authors.lastname: Proctor
authors.forename: Gary F
authors.initials: GF
authors.lastname: Rogers
mesh_terms: D000293:Adolescent; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000601:surgery*; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012886:Skull / Q000002:abnormalities / Q000601:surgery*; D012888:Skull Neoplasms / Q000601:surgery*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt; D055815:Young Adult