Long-Term Outcomes of a Vascularized Pericranial Flap to Prevent Persistent Skull Defects After Craniectomy for...

Sagittal craniectomy for craniosynostosis creates an open calvarial defect, which generally closes within a year. However, some defects may persist and need eventual corrective cranioplasty. We previously demonstrated a significant reduction in the incidence of persistent defects 1 year postoperatively after suturing a vascularized pericranial flap to the dura exposed by sagittal craniectomy. This follow-up study evaluates the long-term postoperative outcomes of this technique. We conducted a retrospective review of a prospectively acquired single-site database of children who underwent primary open sagittal craniectomy with biparietal morcellation for single-suture nonsyndromic sagittal craniosynostosis from March 2013 to November 2020. Children who had follow-up evaluation 5 years (48-72 mo) after surgery were divided into 2 groups: (1) standard craniectomy and (2) craniectomy with vascularized pericranial flap. Additional analyses were conducted for those who had follow-up at ≥3 years. At a mean follow-up of 59.7±6.4 months after surgery, children who received pericranial flaps (N=14) had significantly lower incidence of persistent defect(s) (21.4%), significantly lower mean area of defect(s) (0.9±2.0 cm2) if they had defects, and significantly lower incidence of corrective cranioplasty (7.1%) compared with those who underwent standard craniectomy alone (N=43, incidence of defect=60.5%, mean area=5.0±7.4 cm2, incidence of cranioplasty=37.2%) with P-values of 0.015, <0.002, and 0.044 respectively. These effects were similar when analyzing all children who had follow-up at ≥3 years. Our results suggest that a vascularized pericranial flap can be safely utilized to prevent persistent skull defects after open sagittal craniectomy for craniosynostosis and is associated with a significantly lower rate of eventual cranioplasty.