Factors Associated Bone Flap Resorption Following Pediatric Autologous Cranioplasty in Kalasin Hospital
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Abstract
BACKGROUND: Children account for roughly 4.1% of TBI-related deaths. The most frequent surgery is a decompressive craniectomy (DC) followed by a cranioplasty (CP), which involves a high rate of surgical complications.
OBJECTIVES: This study aimed to assess the risk factors for bone flap resorption (BFR).
METHODS: A retrospective analysis was conducted at Kalasin Hospital, Thailand, utilizing 22 patients who underwent CP with autologous bone flaps from October 2020 to May 2023. Data were collected utilizing medical records and CT brain scans. Data were analyzed by mean and standard Deviation (SD) or median and Interquartile range (IQR) and compared by Fisher’s exact test and Mann-Whitney U test.
RESULTS: Using an autologous bone flap, 22 patients were enrolled in the trial. The mean age was 15±4 years. The most frequent reason for DC was TBI. The median time between DC and CP was 90 days (80-137). The median bone flap size was 73 cm2 (49-122). Surgical complications were experienced by 3 patients (13.6%), with the most frequent complications being BFR (13.6%), which required repeat surgical intervention, implant dislodgement (4.5%), and hydrocephalus (9.1%); one patient required a VP shunt. It was observed that large bone flaps (p=0.04), bone flap size larger than 115 cm2 (p=0.02), and contusional hemorrhage at first admission (p=0.006) were associated with a higher rate of BFR.
CONCLUSIONS: Because of the patient's financial situation and cosmesis, autologous cranioplasty was primarily performed at our hospital. Therefore, it is important to choose a good patient to avoid BFR. Finally, patients with large bone flaps and contusional hemorrhage should also be monitored closely and persistently to track the BFR.
KEYWORDS: pediatric cranioplasty, autologous cranioplasty, bone flap resorption, complication
Thaiclinicaltrials.org number, TCTR20240609003
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