Ahead of Print: Reconstructive Pericranial-onlay Cranioplasty

Screen Shot 2014-02-25 at 12.07.53 PMBackground: Although materials for secondary cranial reconstruction have evolved with time, the overall approach in terms of bone flap/implant reconstruction following necessary delay has remained constant.

Objective: To present our cases series of 50 consecutive secondary cranial reconstruction patients and describe a multidisciplinary cranioplasty approach developed to reduce morbidity, minimize infection, and improve aesthetic appearance.

Methods: Standard technique teaches us to place the bone flap and/or alloplastic implant directly over the dura or dural protectant following scalp flap re-elevation. However, this procedure is fraught with high complication rates including infection. While raising the previously-incised scalp flap overlying the full-thickness calvarial defect, the dissection is performed within the loose areolar tissue plane beneath the galea aponeurosis, thus leaving vascularized pericranium intact over the dura.

Results: A total of 50 consecutive patients were treated by the senior author encompassing 46 cranioplasties using the pericranial-onlay approach, along with 4 isolated temporal soft tissue reconstructions with liquid PMMA. Of the 46 cranioplasties (>5 cm2), only one autologous bone flap developed deep infection necessitating bone flap removal (1/46, 2.17%, 95% CI: 0.003-11.3). None of the alloplastic custom implants since placement have developed any infection requiring removal.

Conclusion: This multidisciplinary approach illustrated in our case series, including our “pericranial-onlay” technique described here for the first time, has the potential to improve patient outcomes, decrease peri-operative morbidity, and minimize costs associated with post-operative infections following secondary cranial reconstruction.

From: Multidisciplinary Approach for Improved Outcomes in Secondary Cranial Reconstruction: Introducing the Pericranial-onlay Cranioplasty Technique by Huang et al.

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