Skip Navigation LinksHome > May 2011 - Volume 127 - Issue 5 > Interval Cranioplasty: Comparison of Current Standards
Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e31820e89a5
Experimental: Original Articles

Interval Cranioplasty: Comparison of Current Standards

Sultan, Steven M. B.A.; Davidson, Edward H. M.A., M.B.B.S.; Butala, Parag M.D.; Schachar, Jeffrey S. B.S.; Witek, Lukasz B.S.; Szpalski, Caroline M.D.; Ricci, Jack L. Ph.D.; Saadeh, Pierre B. M.D.; Warren, Stephen M. M.D.

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Abstract

Background: Although different cranioplasty storage methods are currently in use, no study has prospectively compared these methods. The authors compare freezing and subcutaneous storage methods in a rat model.

Methods: Trephine defects (10 mm) were created in 45 Sprague-Dawley rats. The cranial bone grafts were stored in an autologous subcutaneous pocket (n = 15), frozen at –80°C (n = 15), immediately analyzed (n = 12), or immediately replanted into the defect (n = 3). After 10 days of storage, the subcutaneous or frozen grafts were either replanted (subcutaneous, n = 3; frozen, n = 3) or analyzed (subcutaneous, n = 12; frozen, n = 12). Grafts underwent histologic analysis, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, alkaline phosphatase assay, mechanical testing, and micro–computed tomographic imaging.

Results: After 10 days of storage, physiologic assays demonstrated a significant decrease in cellular functionality (e.g., alkaline phosphatase assay concentration: fresh, 18.8 ± 0.77 mM/mg; subcutaneous, 12.2 ± 0.63 mM/mg; frozen, 8.07 ± 1.1 mM/mg; p < 0.012 for all comparisons). Mechanical integrity (maximal load) of fresh grafts was greatest (fresh, 9.26 ± 0.29 N; subcutaneous, 6.27 ± 0.64 N; frozen, 4.65 ± 0.29 N; fresh compared with frozen, p < 0.001; fresh compared with subcutaneous, p = 0.006). Replantation of subcutaneously stored and frozen grafts resulted in limited bony union and considerable resorption after 12 weeks; in contrast, replanted fresh grafts demonstrated bony union and little resorption.

Conclusions: Current preservation methods for interval cranioplasty do not maintain bone graft viability. Subcutaneous storage appears to provide a small advantage compared with freezing.

©2011American Society of Plastic Surgeons

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