Transplant of Adult Bone for Reconstruction of a Large Post-Traumatic Cranial Defect in a Very Young Baby.

Large cranial defects in very young patients are challenging. The ideal material for cranioplasty in this age group has not yet been identified. Cryopreserved autologous bone presents very high rates of failures, acrylic resins pose a number of compatibility problems, bioceramics may be contraindicated, and autografts may be not adequate for repair of large defects. We present an 18-month-old baby with a large post-traumatic cranial defect which was repaired by assembling a new bone flap on a sterile stereolithographic 3-D model. This customized newly assembled flap consisted of a scaffold of autologous bone (from vault duplication) sustaining 2 large grafts of homologous cadaveric bone. It was adequately modeled and contoured on the 3-D model using metallic plates and screws. Immediately after implantation on the skull, the metallic devices were progressively replaced by reabsorbable material, thus maintaining the previously obtained flap profile. In this paper we detail this original technique which was developed to manage this specific patient.