title: Skull bone flap fixation--comparative experimental study to assess the reliability of a new grip-like titanium device (Skull Grip) versus traditional sutures: technical note.
abstract: BACKGROUND
  After completing a craniotomy, whenever possible, it is crucial to replace and fix the removed bone flap to the cranium; this in order to keep the brain's protection as well as for cosmetic purposes. Visible skull defects might cause patients psychosocial problems and, most importantly, expose the brain to accidental damage. A fixation device should not only provide optimal attachment of the flap to the skull but also allow fast bony healing to avoid possible pseudoarthrosis and/or osteolytic changes.
  
  
  METHODS
  After performing 12 different craniotomies on 4 human cadaver heads the skull flaps were replaced using traditional sutures and a new skull fixation device; for each fixation technique a load-bearing test was performed and the results compared.
  
  
  RESULTS
  Bone flaps fixed with the "Skull Grip" showed a strong fixation with optimal plastic deformation when compared to flaps held by sutures that showed less resistance to pressure and could be easily dislocated.
  
  
  CONCLUSIONS
  The "Skull Grip" has shown to be a reliable, effective, and stronger bone flap fixation superior to suturing technique.
authors.affiliation: Department of Neurosurgery, Lariboisiere University Hospital, Paris, France. schibbaro@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Chibbaro
authors.forename: O
authors.initials: O
authors.lastname: Makiese
authors.forename: G
authors.initials: G
authors.lastname: Mirone
authors.forename: D
authors.initials: D
authors.lastname: Bresson
authors.forename: D
authors.initials: D
authors.lastname: Chauvet
authors.forename: P
authors.initials: P
authors.lastname: Di Emidio
authors.forename: R
authors.initials: R
authors.lastname: Galzio
authors.forename: B
authors.initials: B
authors.lastname: George
mesh_terms: D002102:Cadaver; D003399:Craniotomy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D010014:Osteolysis / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D019736:Prostheses and Implants / Q000592:standards / Q000639:trends*; D011542:Pseudarthrosis / Q000209:etiology / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D015203:Reproducibility of Results; D012886:Skull / Q000033:anatomy & histology / Q000601:surgery*; D013314:Stress, Mechanical; D013524:Surgical Flaps; D014025:Titanium / Q000627:therapeutic use*; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology; D014945:Wound Healing / Q000502:physiology
chemical_list: D014025:Titanium