Interval cranioplasty: Comparison of current standards

Steven M. Sultan, Edward H. Davidson, Parag Butala, Jeffrey S. Schachar, Lukasz Witek, Caroline Szpalski, Jack L. Ricci, Pierre B. Saadeh, Stephen M. Warren

Research output: Contribution to journalArticle

Abstract

Background: Although different cranioplasty storage methods are currently in use, no study has prospectively compared these methods. The authors compare freezing and subcutaneous storage methods in a rat model. Methods: Trephine defects (10 mm) were created in 45 Sprague-Dawley rats. The cranial bone grafts were stored in an autologous subcutaneous pocket (n = 15), frozen at -80°C (n = 15), immediately analyzed (n = 12), or immediately replanted into the defect (n = 3). After 10 days of storage, the subcutaneous or frozen grafts were either replanted (subcutaneous, n = 3; frozen, n = 3) or analyzed (subcutaneous, n = 12; frozen, n = 12). Grafts underwent histologic analysis, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, alkaline phosphatase assay, mechanical testing, and micro-computed tomographic imaging. Results: After 10 days of storage, physiologic assays demonstrated a significant decrease in cellular functionality (e.g., alkaline phosphatase assay concentration: fresh, 18.8 ± 0.77 mM/mg; subcutaneous, 12.2 ± 0.63 mM/mg; frozen, 8.07 ± 1.1 mM/mg; p < 0.012 for all comparisons). Mechanical integrity (maximal load) of fresh grafts was greatest (fresh, 9.26 ± 0.29 N; subcutaneous, 6.27 ± 0.64 N; frozen, 4.65 ± 0.29 N; fresh compared with frozen, p < 0.001; fresh compared with subcutaneous, p = 0.006). Replantation of subcutaneously stored and frozen grafts resulted in limited bony union and considerable resorption after 12 weeks; in contrast, replanted fresh grafts demonstrated bony union and little resorption. Conclusions: Current preservation methods for interval cranioplasty do not maintain bone graft viability. Subcutaneous storage appears to provide a small advantage compared with freezing.

Original languageEnglish (US)
Pages (from-to)1855-1864
Number of pages10
JournalPlastic and reconstructive surgery
Volume127
Issue number5
DOIs
StatePublished - May 1 2011

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ASJC Scopus subject areas

  • Surgery

Cite this

Sultan, S. M., Davidson, E. H., Butala, P., Schachar, J. S., Witek, L., Szpalski, C., Ricci, J. L., Saadeh, P. B., & Warren, S. M. (2011). Interval cranioplasty: Comparison of current standards. Plastic and reconstructive surgery, 127(5), 1855-1864. https://doi.org/10.1097/PRS.0b013e31820e89a5