Page 79 - Clinical relevance of current materials for cranial implants
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Follow-up duration
A substantial proportion of the autologous bone flaps fail in time. Hence, patients
with a long-life expectancy may be better served with an alloplastic cranioplasty. In
the long run, when resorption of an autologous bone flap occurs, the protection of the
brain is diminished, fracture is more likely, and esthetics will be compromised due to
atmospheric air pressure. It may therefore be advisable to develop a protocol to extend 3 the follow-up period. This may result in a more timely intervention when there are
clinical signs for failure of the bone flap, which may reduce definitive bone flap failures in time.
Limitations of this study
The retrospective nature of this study implies a risk of reporting bias, as it was limited to the available information documented in patient charts, including whether or not antibiotics were given. This led to patient exclusions because of unknown follow- up data, which is likely to occur if the follow-up period was uneventful and patients would have no need to visit their surgeon. Thus, the present findings about failure rates might be slightly exaggerated. In addition, the association between bone flap failure and various parameters was statistically significant but with a limited clinical relevance due to the relatively small number of patients available. The impact of these parameters on clinical practice deserves further investigation.
Second, in this study resorption and infection were defined clinically in case of flap removal, although this was not verified microbiologically. However, we think this would not have influenced the results of this study substantially.
Third, the circumference rather than the surface area of the defect was used for the measurements. Because the skull has convex and concave areas, the measurement of the surface area of the defect is complicated. However, the measured circumference is likely to give a reliable indication of the defect in the cranium of the patient.
Autologous cranioplasty
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