title: A simplified technique for polymethyl methacrylate cranioplasty: combined cotton stacking and finger fracture method.
abstract: OBJECTIVE
  Polymethyl methacrylate (PMMA) is one of the most frequently used cranioplasty materials. However, limitations exist with PMMA cranioplasty including longer operative time, greater blood loss and a higher infection rate. To reduce these disadvantages, it is proposed to introduce a new surgical method for PMMA cranioplasty.
  
  
  METHODS
  Retrospective review of nine patients who received nine PMMA implants using combined cotton stacking and finger fracture method from January 2008 to July 2011.
  
  
  METHODS
  The definitive height of skull defect was quantified by computer-based image analysis of computed tomography (CT) scans. Aesthetic outcomes as measured by post-reduction radiographs and cranial index of symmetry (CIS), cranial nerve V and VII function and complications (wound infection, hardware extrusions, meningitis, osteomyelitis and brain abscess) were evaluated.
  
  
  RESULTS
  The mean operation time for implant moulding was 24.56 ± 4.6 minutes and 178.0 ± 53 minutes for skin-to-skin. Average blood loss was 169 mL. All post-operative radiographs revealed excellent reduction. The mean CIS score was 95.86 ± 1.36%, indicating excellent symmetry.
  
  
  CONCLUSIONS
  These results indicate the safety, practicability, excellent cosmesis, craniofacial symmetry and stability of this new surgical technique.
authors: Department of Neurosurgery, Taipei City Hospital, Zhong Xiao Branch, Taipei, Taiwan.
authors: Woon-Man
authors: WM
authors: Kung
authors: Muh-Shi
authors: MS
authors: Lin
mesh_terms: D000328:Adult; D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use*; D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis; D008875:Middle Aged; D061646:Operative Time; D010019:Osteomyelitis; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012886:Skull / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013530:Surgical Wound Infection; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate