Secondary skull reconstruction with autogenous split calvarial bone grafts versus nonautogenous materials

Skull reconstructions, which can be required for various reasons, including decompressive craniectomy, trauma, and tumors, are challenging issues in plastic surgery. Moreover, obtaining a low complication ratio in secondary skull reconstructions is more difficult than in primary skull reconstructions. Because standardized protocols have not been established, we here compare cranioplasty performance using fresh autogenous split calvarial bone grafts and allogenic or alloplastic materials in secondary revisional cases.

Surgical correction of skull defects was performed in 25 patients in our center between 2005 and 2012. Only secondary cranioplasty cases were reviewed retrospectively. There were 17 men and 8 women, with ages ranging from 8 to 62 years at the time of surgery. The mean follow-up was 55.6 months. The surgical procedure in each case was a routine cranioplasty. In most of the cases, a 1-piece split calvarial bone graft was used while minimizing the separation of the bone flap into multiple pieces.

In comparison with the skull reconstructional approach using nonautogenous materials, the functional and esthetic results of skull reconstruction using autogenous calvarial bone grafts were better and more consistent in secondary revisional cases. The group that received autogenous calvarial bone grafts showed a reconstruction success rate of 80% without esthetic and functional complications. In contrast, the group that received nonautogenous materials had a 30% success rate.

Secondary cranial defect reconstructions with autogenous calvarial bone grafts showed better functional and esthetic results than skull reconstructions with nonautogenous materials.