Lin Alexander Y, Kinsella Christopher R, Rottgers S Alex, Smith Darren M, Grunwaldt Lorelei J, Cooper Gregory M, Losee Joseph E
Division of Plastic Surgery and Department of Oral Biology, University of Pittsburgh, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania 15201, USA.
J Craniofac Surg. 2012 Jan;23(1):67-70. doi: 10.1097/SCS.0b013e318240c876.
Some of the most problematic craniofacial injuries in pediatric plastic surgery are large calvarial defects in children who have passed the age of maximal dural osteogenic potential and yet are too young to yield split calvarial grafts. Porous polyethylene (Medpor; Porex) is an alloplastic material that can be customized to precisely match a cranial defect. We present a clinical series that demonstrates successful use of porous polyethylene cranioplasties in large pediatric cranial defects.
From 2007 to 2009, 9 pediatric patients underwent custom-made porous polyethylene cranioplasties for large calvarial defects. Descriptive statistical analyses were performed on the cause of the defects, time to cranioplasty, size of defect, reconstruction technique, and postoperative healing.
A total of 5 boys and 4 girls, with a mean age of 6.8 years, underwent 9 cranioplasties incorporating custom porous polyethylene implants. Initial pathologic findings included 7 patients with traumatic brain injuries, 1 patient with intractable seizures, and 1 patient with brain cancer. Initially, each patient had a craniectomy followed by replacement of the frozen bone "flap." All patients experienced either infection or resorption of the bone leading to a permanent defect. The mean defect size was 152 cm. The mean delay between the removal of failed bone "flap" and the final implant cranioplasty was 6.8 months. At the last follow-up, which averaged 3.6 months, all patients had stable wounds with acceptable cranial contour.
For pediatric large-scale calvarial defects, custom-made porous polyethylene implants can be safely used for cranioplasty. Tissue expansion and acellular dermal matrix were useful tools to help augment the soft tissues of the scalp before cranioplasty to prevent complications of implant extrusion and wound breakdown.
小儿整形外科中一些最具挑战性的颅面损伤是发生在已过硬脑膜成骨潜能最大年龄但又太小而无法提供颅骨劈开移植片的儿童的大型颅骨缺损。多孔聚乙烯（Medpor；Porex）是一种可定制以精确匹配颅骨缺损的异质材料。我们展示了一个临床系列，证明多孔聚乙烯颅骨成形术在小儿大型颅骨缺损中的成功应用。
2007年至2009年，9例小儿患者因大型颅骨缺损接受了定制的多孔聚乙烯颅骨成形术。对缺损原因、颅骨成形术时间、缺损大小、重建技术和术后愈合情况进行了描述性统计分析。
共有5名男孩和4名女孩，平均年龄6.8岁，接受了9次包含定制多孔聚乙烯植入物的颅骨成形术。最初的病理结果包括7例创伤性脑损伤患者、1例顽固性癫痫患者和1例脑癌患者。最初，每位患者均进行了颅骨切除术，随后替换冷冻骨“瓣”。所有患者均经历了骨感染或吸收，导致永久性缺损。平均缺损大小为152平方厘米。失败的骨“瓣”移除与最终植入物颅骨成形术之间的平均间隔时间为6.8个月。在平均3.6个月的最后一次随访中，所有患者伤口均稳定，颅骨轮廓可接受。
对于小儿大型颅骨缺损，定制的多孔聚乙烯植入物可安全用于颅骨成形术。组织扩张和脱细胞真皮基质是在颅骨成形术前帮助扩大头皮软组织以防止植入物挤出和伤口裂开并发症的有用工具。
