S9A-10 SESSION 9A: CRANIOPLASTY COMPARISON OF CRANIOPLASTY TECHNIQUES UTILIZED TO RECONSTRUCT COMPOSITE FULL-THICKNESS SCALP DEFECTS

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Introduction: Composite scalp defects involve both cranial bone and the overlying scalp soft tissue and skin. They are particularly difficult to reconstruct. The ideal reconstruct would restore both the cranial bone as well as the scalp soft tissue. Often preference is placed on the reconstruction of the scalp skin and soft tissue. As such, the ideal technique and timing of cranioplasty to repair the missing skull is still unknown in this clinical situation. Methods: A retrospective chart review was performed at a tertiary academic medical center. All subjects who underwent composite scalp skin and cranial skull resection from July 2011 through September 2018 were enrolled. Reconstructions were classified by: (1) type of cranioplasty performed, (2) timing of cranial repair (primary or delayed), (3) exposure to radiation therapy. Fisher’s exact test and chi squared test were used for statistical analysis. Results: Fifty subjects underwent composite scalp resection and reconstruction during this study period. Forty cranial reconstructions were performed as part of the 50 reconstructions with 10 receiving skin/soft tissue only. Three subjects required two or more reconstructions. Twenty-nine cranioplasties were performed primarily at the time of resection and 11 were done in a delayed fashion for concern of infection with no differences in compllications. Autologous reconstructions was performed for 19 subjects including: non-vascular split cranial bone grafts (n=7) and vascularized bone (n=12). Alloplastic reconstructions were performed in 21 subjects including: titanium (n=10) and polyetheretherketone, or PEEK, (n=11) implants. There were 8 total complications, due to partial flap loss and implant exposure (n=5), cranioplasty infection (n=2), and wound dehiscence (n=1). Alloplastic implants were more likely to experience complications than autogenous overall (33.3% vs 5.3%, p=0.046). Titanium demonstrated significantly higher rates of complications than all other cranioplasty techniques (60.0% vs 6.9%, p=0.014). Exposure to radiation treatment did not affect rates of complications (p=0.736). Conclusion: Composite reconstruction of the skull and scalp requires careful consideration, especially in regard to the method of cranial reconstruction. In our experience, complete autologous cranioplasty is preferable and demonstrates fewer complications than alloplastic reconstruction.