Cranioplasty in children with split rib graft

Abstract

Defect of the cranial vault results from trauma, decompression craniotomies and ablative tumour resection. These patients suffer from the feeling of insecurity as the brain tissue is prone to trauma in exposed regions. Cranioplasty not only provides mechanical protection to the cerebrum but also improves cosmesis. Unexpected neurological recovery due to change in cerebral haemodynamics has been reported by Richaud et al [1]. The goal of a cranioplasty procedure is to achieve a lifelong, stable, structural reconstruction of the cranium covered by a healthy skin and scalp flap [2, 3]. The successful clinical outcome relies upon the following factors: 1 The selection of an implant to reproduce the rigid framework of the skull. 2 Preparation of the recipient bed to optimize implant stability and vascularity. In children use of alloplastic materials are disadvantageous as they are biologically inert and fail to keep up with the dynamic contouring of the developing skull. The autogenous bone graft, with its ability to become incorporated as living tissue and good reparative capabilities is the material of choice for cranioplasty. Various sources of autogenous bone grafts are calvarium, ilium and rib. Autogenous split calvarial graft is material of choice for being the bone of same origin, volume available, same operating site and favourable contour. In children below nine years of age harvesting a split calvarial graft is difficult due to poor differentiation of the dipolic bone. Harvesting of iliac crest is also contraindicated below nine years, as it interferes with growth. Hence rib graft is the only viable option in children. We present a case of post traumatic cranial defect in a three year old child treated at our institution with split rib graft.