From the Department of Plastic Surgery, University of Pittsburgh, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center; the University of Massachusetts-Baystate, Baystate Medical Center; and the Drexel University College of Medicine.
Plast Reconstr Surg. 2020 Jan;145(1):137e-141e. doi: 10.1097/PRS.0000000000006386.
Replacement of the autologous bone flap after decompressive craniectomy can be complicated by significant osteolysis or infection with large defects over scarred dura. Demineralized bone matrix is an alternative to autologous reconstruction, effective when reconstructing large defects using a resorbable mesh bilaminate technique in primary cranioplasty, but this technique has not been studied for revision cranioplasty and the setting of scarred dura. Retrospective review was performed of patients receiving demineralized bone matrix and resorbable mesh bilaminate cranioplasty for postdecompressive craniectomy defects. Seven patients (mean age, 4.2 years) were identified with a mean follow-up of 4.0 years. Computed tomography before the demineralized bone matrix and resorbable mesh bilaminate cranioplasty and at least 1 year postoperatively were compared. Defects were characterized and need for revision was assessed. All patients had craniectomy with associated hemidural scarring. Five patients had autologous bone flap cranioplasty associated with nearly total osteolysis, and two patients had deferral of bone flap before demineralized bone matrix and resorbable mesh bilaminate cranioplasty. Demineralized bone matrix and resorbable mesh bilaminate cranioplasty demonstrated unpredictable and poor ossification, with bony coverage unchanged at postoperative follow-up. All patients required major revision cranioplasty at a mean time of 2.5 years. Porous polyethylene was successfully used in six of the revisions, whereas exchange cranioplasty was used in the remaining patient, with a mean follow-up of 1.4 years. Although demineralized bone matrix and resorbable mesh bilaminate is appropriate for primary cranioplasty, it should be avoided in the setting of scarred or infected dura in favor of synthetic materials or exchange cranioplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
去骨瓣减压术后自体骨瓣的替换可能会因严重的骨质溶解或伴有瘢痕硬脑膜的大缺损而发生感染。脱矿骨基质是自体重建的一种替代方法，当使用可吸收的双层网片技术在原发性颅骨成形术中重建大缺损时，它是有效的，但这种技术尚未在颅骨修补术和瘢痕硬脑膜的翻修中进行研究。对接受脱矿骨基质和可吸收双层网片颅骨成形术治疗去骨瓣减压术后缺损的患者进行了回顾性研究。共确定了 7 名患者（平均年龄为 4.2 岁），平均随访时间为 4.0 年。比较了脱矿骨基质和可吸收双层网片颅骨成形术前和术后至少 1 年的计算机断层扫描。评估了缺损的特征和需要翻修的情况。所有患者均行去骨瓣减压术，伴半硬脑膜瘢痕形成。5 例患者行自体骨瓣颅骨成形术，伴几乎完全骨质溶解，2 例患者在行脱矿骨基质和可吸收双层网片颅骨成形术之前推迟了骨瓣。脱矿骨基质和可吸收双层网片颅骨成形术显示出不可预测和较差的成骨作用，术后随访时骨覆盖无变化。所有患者均在平均 2.5 年时需要进行主要的翻修颅骨成形术。在 6 例翻修术中成功使用了多孔聚乙烯，而在其余 1 例患者中使用了更换颅骨成形术，平均随访时间为 1.4 年。尽管脱矿骨基质和可吸收双层网片适用于原发性颅骨成形术，但在伴有瘢痕或感染硬脑膜的情况下，应避免使用该材料，而应选择合成材料或更换颅骨成形术。临床问题/证据水平：治疗，IV。
