title: Management of cranial bone defects: a reconstructive algorithm according to defect size.
abstract: BACKGROUND
  Reconstruction of cranial bone defects is one of the most challenging problems in reconstructive surgery. The timing of reconstruction, the location of the defect, the materials to be used, and the medical history of the patient are parameters that have been mostly discussed in the literature. To the best of our knowledge, there has not been any published classification for the cranial bone defect reconstruction according to defect size.
  
  
  METHODS
  Twelve patients underwent reconstruction of cranial vault defects. Cranial bone defects were classified into 3 groups according to the size of the defect. The small-sized group included the defects smaller than 25 cm(2), the medium-sized group included the defects between 25 to 200 cm(2), and the large-sized group included the defects larger than 200 cm(2). The small-sized defects were reconstructed with split calvarial graft, demineralized bone matrix, or hydroxyapatite cement; the medium-sized defects were reconstructed with split calvarial graft or allogenic bone graft; and the large-sized defects were reconstructed with methyl methacrylate, autoclaved bone, or porous polyethylene.
  
  
  RESULTS
  Two patients needed revision for irregularities with demineralized bone matrix. Other patients had no skull defects or irregularities for which revision was suggested.
  
  
  CONCLUSIONS
  We believe that the size of the defect is important for the reconstruction of cranial vault defects and that using a standard algorithm can increase the success rate.
authors.affiliation: From the *Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University Faculty of Medicine, Ankara; and †Department of Plastic, Reconstructive and Aesthetic Surgery, Koc University School of Medicine, Istanbul, Turkey.
authors.forename: Safak
authors.initials: S
authors.lastname: Uygur
authors.forename: Tolga
authors.initials: T
authors.lastname: Eryilmaz
authors.forename: Onur
authors.initials: O
authors.lastname: Cukurluoglu
authors.forename: Selahattin
authors.initials: S
authors.lastname: Ozmen
authors.forename: Reha
authors.initials: R
authors.lastname: Yavuzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D064591:Allografts / Q000637:transplantation; D001672:Biocompatible Materials / Q000627:therapeutic use; D001857:Bone Matrix / Q000637:transplantation; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006882:Hydroxyapatites / Q000627:therapeutic use; D008297:Male; D020366:Methylmethacrylate / Q000627:therapeutic use; D010347:Patient Care Planning; D020959:Polyethylene / Q000627:therapeutic use; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012886:Skull / Q000293:injuries* / Q000601:surgery; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials; D018786:Bone Substitutes; D006882:Hydroxyapatites; C475044:hydroxyapatite cement; D020366:Methylmethacrylate; D020959:Polyethylene