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Autogenous Reconstruction of Large Secondary Skull Defects
Devan Griner, MD1, Kanlaya Ditthakasem, MNS, RN2, Morley Herbert, PhD2, Jeffrey A. Fearon, MD3.
1The University of Tennesse Chatanooga, Chatanooga, TN, USA, 2The Department of Research, Medical City Dallas Hospital, TX, USA, 3The Craniofacial Center, Dallas, TX, USA.

Purpose: As defect sizes increase, skull reconstructions become more challenging, forcing many to use alloplasts. We sought to ascertain the upper limits of autogenous reconstructions and examine outcomes compared with published data on synthetic reconstructions.
Methods: A retrospective review of all autogenously reconstructed critical-sized secondary skull defects was undertaken. A literature search (Cochrane databases, Ovid, PubMed) was performed using the key words: "cranioplasty," "skull defect," and "calvarial defect," with <10 patients and <1-year follow-up as exclusion criteria.
Results: Over 14 years, 133 patients were reconstructed exclusively with autogenous bone and 96 had complete records. The mean reconstructive age was 12.9 years (1 - 65 years) and the defect size averaged 93 cm2; 23% had extremely large defects, between 120 and 506 cm2. 30% had undergone prior reconstruction elsewhere using alloplasts. Operative time averaged 3.4 hours, transfusion rates: 2%, hospital LOS: 3 days, and follow up: 23 months (max: 19.6 years). There were no postoperative infections. One patient (1%) experienced a partial resorption and underwent a secondary cranioplasty. 27 studies (1954 patients) met our inclusion criteria for a meta-analysis. Compared with published alloplastic reconstructions, infection and other complication rates were significantly lower for this autogenous series: 5.7% vs. 0% (p<0.016) and 9.4% vs. 2% (p<0.015), respectively.
Conclusions: While many surgeons faced with large secondary skull defects might be compelled to use alloplasts, autogenous reconstructions are technically feasible with skull defect sizes as large as 500 cm2. Compared with alloplasts, autogenous reconstructions have significantly lower long-term infection and complication rates.


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