A variety of materials are currently implanted in the reconstruction of bony defects of the cranial vault. Traditionally, autologous bone demonstrates low rates of resorption, extrusion, and infection. Alloplastic materials are available in nearly unlimited supply and obviate donor site morbidity. One of the earliest alloplastic materials used in cranioplasty was polymethylmethacrylate (PMMA), a malleable and inert implant material. More recently, biocompatible cements such as hydroxyapatite cement have gained rapid acceptance. However, our experience has led us to return to PMMA in craniofacial reconstruction because of its excellent cosmetic and functional results in addition to the low incidence of complications. In the last 6 years, we have implanted PMMA in the treatment of craniofacial defects in 30 patients with only one postoperative infection requiring implant removal. Three other minor complications resolved with expectant management. We believe that this low rate of complications was due, in part, to key methods of implant stabilization as well as the use of antibiotic-impregnated implant material. These methods are presented herein and are differentiated based on the use of PMMA for restoration of full-thickness defects versus augmentation of partial-thickness defects or bony deficiencies.
European Journal of Plastic Surgery – Springer Journals
Published: Feb 1, 2012
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