Calvarial Reconstruction Following Massive Tissue Loss: A Feasible Treatment Strategy and Surgical Technique.

BACKGROUND: Severe cranial injuries require reconstructive surgeries to protect the underlying brain and to restore cranial contour and scalp integrity, as well as avoid complications such as neurocognitive decline. In cases of full-thickness cranial tissue damage, adept surgical skill in both bone and soft tissue reconstruction is critical for a minimally invasive surgery and successful bone integration without endangering previous soft tissue efforts. Different surgical techniques and materials are beset with various problems. OBJECTIVE: To present a surgical procedure intended for the reconstruction of complex calvarial and associated tissue defects with reduced invasiveness and improved soft tissue healing compared to the existing gold standard. Both soft tissue and bone reconstruction techniques are described in detail due to their intertwined importance for successful full thickness skull and scalp reconstruction. METHODS: During initial medical care, aseptic wound treatment and temporary wound closure are performed. Two weeks postinjury, extensive necrotic tissue debridement and soft tissue reconstruction lay the foundation for well-vascularized tissue regeneration. Soft tissue healing is followed by minimally invasive cranioplasty using autologous split-rib transplants after approximately 6 mo. RESULTS: With consideration of the established gold standards for treatment, soft tissue regenerated without complications. The minimally invasive insertion of autologous rib grafts underneath the healed soft tissue allowed for quick recovery without requiring further follow-up treatments. CONCLUSION: We optimized initial scalp wound healing and bone regeneration by making use of minimally invasive procedures and autologous materials, offering a viable treatment alternative to existing methods for treating large cranial bone injuries.

The feasibility of rib grafts in long span mandibular defects reconstruction: A long term follow up.

AIMS: To evaluate the efficiency of reconstruction of long span mandibular defects using split rib bundle bone graft. MATERIALS AND METHODS: Six hundred patients with long span mandibular defects (more than 6 cm long), following resection of aggressive mandibular tumours, were reconstructed with split rib bundle bone graft technique. Immediate reconstruction was performed in all patients. A reconstruction plate was used to support the graft. Two ribs were harvested from the right side of the chest, split into four halves and used to restore the continuity of the mandible. The inclusion criterion was post-surgical mandibular bony defects without soft tissue deficiency. Defects with a history of previous or need of future irradiation were excluded. RESULTS: The appearance of the patients was accepted in 550 patients. Functional reconstruction was done in 320 patients by osseointegrated dental implants (after 15 months), and removable prosthesis in 150 patients. Infection was minor in 31 patients, moderate in 47 patients and severe in 42 patients. Partial loss of graft, up to 25%, due to moderate infection was reported. Total or near total loss of graft due to severe infection was corrected by reoperation six months later. CONCLUSIONS: This technique is simple, safe, and can be effectively used to reconstruct long-span mandibular defects with minimal complications in selected patients.