A new technique for cranial bone osteofixation: use of bioabsorbable tacks and plates to fix parietal bone split grafts used for reconstruction of a posttraumatic frontal bone defect.

Recent advances in bioabsorbable devices have introduced tacks that do not require tapping. This may help to reduce operative time and, consequently, costs. The goal of this study was to demonstrate the feasibility of a new method of cranial bone osteofixation using novel bioabsorbable tacks and plates instead of screws. A 36-year-old man presented for elective cranioplasty to reconstruct a large frontal cranial bone defect that followed a decompression operation performed because of a head injury sustained 6 months previously. Cranioplasty was performed using split parietal bone grafts to reconstruct the defect. Bone grafts were fixed together and to the skull using self-reinforced (SR) poly(L/DL)lactide [SR-poly(L/DL)lactide] (70/30) (Biosorb FX) plates (n = 10) and tacks (n = 98). The plates were 0.6 mm thick, 102 mm long, and 12 mm wide. The tacks had a maximum thread diameter of 2 mm and a length of 6 mm. The tacks used did not require any tapping procedure, and they were applied using a special applicator gun. Stable and secure fixation was obtained during surgery. The postoperative period was uneventful, except for delayed epithelialization of a small area (1 x 0.5 cm) over the frontal skin that healed later. One year after surgery, the cosmetic result was excellent, and no complications were detected. Stabilization of large cranial bone pieces can be achieved using bioabsorbable SR-poly(L/DL)lactide plates and tacks, with excellent cosmetic results. The method is thought to be reliable and may help to reduce operative time.