Successful use of rib grafts for cranioplasty in children

Numerous materials are available for use in cranioplasty including bone, pl astics and metals. Rib grafts as a construct for cranial reconstruction off er several advantages: autologous bone source, a formable platform, low inf ection, regeneration at the donor site and high fusion rates. Criticism of rib graft cranioplasty includes scarring and pain at the donor site, irregu lar contour at the graft site and graft reabsorption. Since 1988, we have p erformed rib autograft cranioplasty on 13 patients. Seven females and 6 mal es combined for an average age of 6 years (11 months to 20 years) at the ti me of surgery. The mean follow-up from surgery is 27 months (2-48 months), with 11 subjects having at least 12 months. The commonest reasons for crani al reconstruction were: post-traumatic calvarial defect (n = 4), defect fro m previous craniotomy (n = 3), 'growing' skull fracture (n = 2), and defect from previous encephalocele closure (n = 2). Mean defect size was 41 cm(2) (8-144 cm(2)) and average number of ribs harvested was 1.75 (1-3). Simple rib cranioplasty had a mean time in the operating room of 6 h and 30 min. N o donor site complications were noted (pneumothorax, significant post-opera tive pain) and no post-operative infections were encountered. Excellent cra nial contour was achieved in each of the 11 patients followed for a minimum of 12 months. One subject required staged reconstructive procedures owing to the size of the defect. Copyright (C) 2001 S. Karger AG, Basel.