Clinical observation on the early replantation of autologous periosteum-preserved skull flap

Abstract

Objective To investigate the feasibility of preservation of the skull flap covered with periosteum in vivo and early cranioplasty in patients with decompressive craniectomy. Methods Sixty-seven patients underwent autologous cranioplasty using periosteum-covered skull flap preserved subcutaneously after decompressive craniectomy from January 2012 to December 2015 at Neurosurgery Department of Rizhao People's Hospital. Their data were retrospectively reviewed. Cranioplasty was conducted within 4-8 weeks after decompression for all patients. Part of the skull flap tissue was obtained in cranioplasty for identification of the bone activity by pathological examination. At follow-up, all patients received CT scan and 34 patients underwent SPECT to assess the healing and survival of skull flap. Results The size of skull flap in the 67 patients with cranioplasty remained the same as that at the time of decompression. Bones were not destructed, focal dead bone was not observed by the pathological examination. The postoperative follow-up lasted 1-2 years and CT scans revealed that the healing rate was 0%, 62.7% (42/67), and (67/67), 100% (53/53) at 1, 6, 12, 24 months after cranioplasty. No skull resorption was reported. Bone survival and good blood supply of the skull flap were demonstrated by SPECT. During the follow-up period, 1 (1.5%) patient had small subcutaneous hematoma, 4 (6.0%) patients developed subcutaneous effusion, and no intracranial or subcutaneous infection was observed. Conclusion Biological activities of skull flap in patients with decompressive craniectomy could remain well through subcutaneous preservation with periosteum, which might be useful for facilitating the good outcome of cranioplasty. Key words: Decompressive craniectomy; Periosteum; Transplantation, autologous; Cranioplasty; Preservation in vivo