RECONSTRUCTION OF SKULL DEFECTS IN CHILDREN AND ADOLESCENTS BY THE USE OF FIXED CRANIAL BONE-GRAFTS - LONG-TERM RESULTS

THIS ARTICLE PRESENTS the long-term results of skull defect reconstruc tion in a series of 27 children studied between 1986 and 1990 (mean ag e, 8.4 yr; range, 1-17 yr). Causes of their defects were encephalocele (six patients), trauma (seven patients), tumor (eight patients), fibr ous dysplasia (two patients), postsynostectomy defects (two patients), osteomyelitis (one patient), and Reye's syndrome with bone flap loss (one patient). All patients underwent clinical and computed tomographi c scan documentation of their skull defects before and immediately aft er surgery and at least 1 year later. The average preoperative defect surface area measured 33 cm2 (range, 2.5-114 cm2). Skull defects were reconstructed in all patients with fixed autogenous cranial bone graft s. In the initial five patients, the grafts were fixed with interosseo us wires, and in the remainder, they were fixed with a combination of miniplates and microplates and screws. Follow-up ranged from 12 to 66 months (mean, 31.4 mo). Complications were minimal, with no infection, plate or graft exposure, or intracranial injuries. In 24 of 27 patien ts, clinical examination and computed tomographic scans showed no evid ence of skull defect or appreciable irregularity of donor or recipient sites. Two patients had documented small regions of graft resorption. One skull had palpable contour irregularities but without a bony defe ct. All patients have resumed routine activities and sports without sp ecial head protection. Repair of skull defects in children with fixed autogenous cranial grafts is a reliable method of reconstruction with minimal morbidity. Although we prefer miniplates and microplates and s crews for fixation, the grafts fixed in place with interosseous wires did equally well.