Changes in graft thickness after skull defect reconstruction with autogenous split calvarial bone graft.

The ideal material for primary reconstruction of skull defect would be the autogenous bone. However, the long-term evaluation regarding the change in bone graft thickness has not been reported. In this article, we analyzed the thickness changes of the graft according to the time period. Between March 2005 and February 2011, a total of 29 patients underwent skull reconstruction with autogenous split calvarial bone grafts. After applying exclusion criteria, computed tomographic (CT) images of 15 patients were analyzed. The donor bone was harvested in full thickness as 1 piece and then as split. One half of the bone plate was transferred to the defect site; the other half, to the donor site. Both halves were fixed with titanium plates. To compare graft thickness changes, immediate postoperative and follow-up CT scans were analyzed by a single researcher. An anatomic reference was appointed for each patient, and the thickness of the graft on the same level was measured on time-series CT images. Collected data were analyzed with a polynomial random coefficient model. The main causes of the skull defects were trauma and tumor excision. In all cases, the graft thickness was not decreased but even increased in both the donor and recipient sites. The mean graft thicknesses between 6 months and 1 year after the surgery as well as those between 2 and 3 years after the surgery were 1.24-times and 1.56-times thicker than the immediate postoperative thickness, respectively. Graft thickness turned out to be either maintained or increased over time.

Use of tattooing to camouflage various scars.

BACKGROUND: Tattooing often is overlooked by plastic surgeons when treating scars. However, some scars are not apt for surgical scar revision and cannot be dramatically improved by laser treatment either. Tattooing can be considered as a simple alternative in such situations. METHODS: The medical records of all the patients who underwent medical tattooing for causes other than routine nipple-areolar reconstruction between 2008 and 2010 were collected. Pre- and postoperative photographs were reviewed. RESULTS: A total of 32 mature scars in 28 patients were treated with tattooing. The scars treated were mainly categorized as depigmented (skin or vermilion) or hairless. The median follow-up period was 14 months, and a retouch procedure was required in 31% of the cases. No significant complications developed, and the patients were generally satisfied. CONCLUSION: Tattooing can be applied in treating scars when conventional methods are not indicated. It can be used for the alopecia scar of a patient who does not want a hair graft, for the depigmented scar that would not benefit dramatically from laser treatment, or as camouflage for a three-dimensional structure when surgical reconstruction is not feasible.