ABSTRACT
Cranioplasty is a widely employed procedure for restoration of calvarial form and shape. The use of autogenous bone flap offers biological reconstruction with minimal donor site morbidity. One of the options to re-use bone autograft is low temperature preservation followed by autoclaving during cranioplasty. A retrospective evaluation of 12 patients with a mean age of 32.58â±â10.04 years who underwent frozen autogenous autoclaved bone cranioplasty was done. Cranial bone flaps were removed during the initial craniectomy and stored at 4°C for 20âminutes followed by preservation at -40°C in the deep freezer of the blood bank. Cranioplasty subsequently was performed at a mean time period of 172.17â±â26.20 days by thawing the bone at room temperature followed by autoclaving at 121°C under 15 psi for 40 minutes. Data regarding patients' characteristics and complications were recorded. Clinical outcomes based on skull shape and symmetry, cosmesis and scars were analyzed by a panel of 4 raters, including 3 doctors and 1 patient. Radiological outcomes were analyzed based on remaining bone thickness and bone gap widening. The present study revealed functionally, structurally, and cosmetically satisfying results. All the cases had satisfactory healing and no incidence of bone graft infection. The skull shape and symmetry, cosmesis and scars revealed excellent to moderate improvement in three-fourth of the patients. Radiological outcomes revealed none of the patients had severe resorption requiring surgical revision with excellent to good implant alignment in 92% of cases. It was concluded that frozen autogenous cranial bone flaps sterilized by autoclaving is safe and effective material for cranioplasty.
Subject(s)
Skull/surgery , Adult , Bone Transplantation/methods , Cicatrix/surgery , Female , Freezing , Humans , Male , Middle Aged , Neurosurgical Procedures , Osteomyelitis/surgery , Postoperative Complications/etiology , Retrospective Studies , Sterilization , Surgical Flaps/surgery , Treatment Outcome , Wound Healing , Young AdultABSTRACT
PURPOSE: Autologous bone removed at the time of decompressive craniectomy (DC) is always the first choice for cranioplasty. The aim of this study was to evaluate the therapeutic efficacy of cranioplasty after DC by measuring the changes in the Functional Independence Measure (FIM) score, as well as to draw a comparison with the pre-cranioplasty FIM score and to evaluate the differences in the outcomes of cases managed by 2 methods: autologous bone (group I) or titanium mesh (group II). MATERIALS AND METHODS: We included 47 patients (36 male and 11 female patients) who underwent unilateral cranioplasty after DC for traumatic brain injury at our institute from 2008 to 2017 in this analytical single-institution retrospective study. The primary binary predictor variable was cranioplasty reconstructive material (autologous bone or mesh). The primary outcome variable of interest was increased, decreased, or unchanged FIM score. The secondary outcome variables included evaluation of immediate complications. The Mann-Whitney U test was used to evaluate differences between scores. RESULTS: Group I (n = 26) underwent cranioplasty using autologous bone flap, whereas group II (n = 21) underwent cranioplasty using dynamic titanium mesh. Increases in FIM scores on the motor function subscale for group I (P = .01278) and group II (P = .00112) were statistically significant. Increases in FIM scores on the cognition subscale for group I (P = .17384) and group II (P = .9492) were statistically insignificant. Evaluation of the primary outcome variable (ie, increased, decreased, or unchanged FIM scores) and secondary outcome variables (ie, immediate complications) showed a statistically insignificant difference between the 2 groups with respect to improvement (P = .51). CONCLUSIONS: This study showed that cranioplasty, irrespective of the reconstructive material, after DC in patients with traumatic brain injury results in a significant functional improvement apart from form and esthetics.
Subject(s)
Brain Injuries, Traumatic/surgery , Decompressive Craniectomy , Plastic Surgery Procedures/methods , Adult , Bone Transplantation/methods , Female , Humans , Male , Retrospective Studies , Surgical Flaps , Surgical Mesh , Titanium , Transplantation, Autologous , Treatment OutcomeABSTRACT
Acquired Brown's syndrome is a rare entity. Delay in treatment can cause fibrosis or scarring with questionable prognosis of vertical diplopia. To the best of the knowledge of the authors the present case of 22-year-old male is the first in existing literature where delayed release of superior oblique muscle entrapment in orbital roof fracture was found to be an effective technique.
