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Demineralized Bone Matrix and Resorbable Mesh Bilaminate Cranioplasty: A Novel Method for Reconstruction of Large-Scale Defects in the Pediatric Calvaria

Chao, Mimi T. M.D.; Jiang, Shao M.D.; Smith, Darren M.D.; DeCesare, Gary E. M.D.; Cooper, Gregory M. Ph.D.; Pollack, Ian F. M.D.; Girotto, John M.D.; Losee, Joseph E. M.D.

Plastic and Reconstructive Surgery: March 2009 - Volume 123 - Issue 3 - p 976-982
doi: 10.1097/PRS.0b013e31819ba46f
Pediatric/Craniofacial: Original Articles

Background: Pediatric patients with large-scale calvarial defects often lose the osteogenic potential of their dura before developing a diploic space sufficient to facilitate harvest of split-thickness calvarial grafts. The authors present their experience using demineralized bone matrix and resorbable mesh bilaminate for the repair of large-scale cranial defects in pediatric patients.

Methods: A retrospective review of the Cleft-Craniofacial Center database at Children’s Hospital of Pittsburgh was performed from 2003 through 2007. Patients who underwent cranioplasties using demineralized bone matrix and resorbable mesh bilaminate were identified. Indications, defect size, quantity of demineralized bone matrix used, complications, follow-up, and computed tomographic scans were reviewed.

Results: Eleven patients underwent 13 skull reconstructions using demineralized bone matrix and resorbable mesh bilaminate cranioplasty. Mean age was 3.6 years (range, 2.1 to 4.9 years); average defect size was 30.8 cm2 (range, 6.6 to 80.0 cm2). Mean clinical follow-up was 29.3 months (range, 13.4 to 41.8 months). All patients had follow-up computed tomographic scans. The average time of follow-up scan was 18.7 months postoperatively (range, 6.9 to 32.6 months). Seven patients had immediate postoperative scans in addition to long-term follow-up scans, facilitating the calculation of a 98 percent average defect healing (range, 95 to 100 percent). All patients had clinically stable cranial reconstructions at follow-up.

Conclusions: When autogenous bone is not available, demineralized bone matrix and resorbable mesh bilaminate cranioplasty is an alternative method of calvarial reconstruction when used in a healthy site free of scarring or infection. This cranioplasty technique has provided consistent bony regeneration, with no donor-site morbidity.

Pittsburgh, Pa.; and Rochester, N.Y.

From the Divisions of Pediatric Plastic Surgery and Pediatric Neurosurgery, Children’s Hospital of Pittsburgh, University of Pittsburgh, and the Division of Plastic Surgery, Golisono Children’s Hospital, University of Rochester.

Received for publication April 21, 2008; accepted September 10, 2008.

Presented in part at the Northeastern Society of Plastic Surgeons, in Washington, D.C., November 3 through 6, 2005; the 63rd Annual Meeting of the American Cleft Palate–Craniofacial Association, in Vancouver, British Columbia, Canada, April 2 through 8, 2006; and the XIIth Biennial International Congress of the International Society of Craniofacial Surgery, in Salvador, Bahia, Brazil, August 23 through 25, 2007.

Disclosure: Dr. Losee receives funding in the form of educational and research grants from the manufacturer of DBX (Synthes North American). The other authors have no financial interests to disclose.

Joseph E. Losee, M.D., Pittsburgh Cleft-Craniofacial Center, University of Pittsburgh School of Medicine, 3705 Fifth Avenue, Pittsburgh, Pa. 15213-2583,

©2009American Society of Plastic Surgeons