The repair of congenital and acquired skull defects in childhood

Abstract

Methylmethacrylate (sulfix-6 and palakos) are very useful materials for the closure of skull defects. The age of the patient and the time of operation are of secondary importance. These substances have the lowest complication rate, can be easily handled and produce a cosmetically satisfactory result. Rib transplants have in our hand not been associated with any complications, but they are cosmetically not always satisfactory as palpable spaces between the ribs remain and the postoperative wearing of a protective helmet is advisable. The use of the patient's own piece of skull or the external lamina are less satisfactory because there is always a tendency of absorption. Nevertheless, it should be used as a primary measure. In all the operations, meticulous sterility is mandatory and a sufficiently large and viable flap of scalp and galea must be used. In children with encephaloceles, cerebral spinal fluid fistulae have to be closed completely watertight. This can only be achieved by a multiple layer closure of the soft tissues; fibrin seal has been found to be especially useful in this operation.