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Autogenous Bone Cranioplasty: Review of a 42-Year Experience by a Single Surgeon

Cabbad, Nicole C. M.D., M.B.A.; Stalder, Mark W. M.D.; Arroyave, Aaron B.S.; Wolfe, Erin M. B.S.; Wolfe, S. Anthony M.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1713-1723
doi: 10.1097/PRS.0000000000005677
Pediatric/Craniofacial: Original Articles
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Background: Autogenous bone is frequently espoused as the gold standard material for cranioplasty procedures, yet alloplastic cranioplasty continues to persist in the search, presumably, for a simpler technique. Although short-term outcomes can be successful using foreign materials, long-term follow-up in these patients often demonstrates increased rates of failure because of exposure or late infection. Autogenous bone grafts, however, integrate and revascularize, and are thus more resistant to infection than alloplastic materials.

Methods: This is a retrospective review of all patients that underwent reconstructive cranioplasty for full-thickness defects, as performed by the senior author (S.A.W.) between 1975 and 2018. All procedures were performed with autogenous bone.

Results: One hundred fifty-four patients met criteria for inclusion in the report. Cranioplasties were performed for both congenital and secondary indications. Split calvaria was used in 115 patients (74.7 percent), rib graft was used in 12 patients (7.8 percent), iliac crest graft was used in 10 patients (6.5 percent), and combinations of donor-site grafts were used in 17 patients (11.0 percent). In the entire series, none of the patients suffered from complications related to infection of either the donor site or transferred bone graft. None of the patients required secondary operations to fill in defects created by the postoperative resorption.

Conclusions: Although autologous bone is widely considered the gold standard material for cranioplasty procedures, some argue against its use, mainly citing unpredictable resorption as the purported disadvantage. However, it is less susceptible to infection, and results in fewer long-term complications than alloplastic materials. There is no alloplastic material that has matched these outcomes, and thus autogenous bone should be considered as the primary option for cranioplasty procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Miami, Fla.; and New Orleans, La.

From the Department of Plastic and Reconstructive Surgery, Nicklaus Children’s Hospital; the Herbert Wertheim College of Medicine, Florida International University; and the Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center.

Received for publication November 12, 2017; accepted November 13, 2018.

Disclosure:The authors have no financial disclosures related to this research article.

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S. Anthony Wolfe, M.D., Nicklaus Children’s Hospital, 3100 SW 62nd Avenue, Suite 2230, Miami, Fla. 33155, drwolfe@santhonywolfemd.com

Copyright © 2019 by the American Society of Plastic Surgeons