A comparison between autograft alone, bone cement, and demineralized bone matrix in cranioplasty.

OBJECTIVES To compare bone autograft, bone cement, and demineralized bone matrix in functional and aesthetic outcomes and complications following cranioplasty for reconstruction of cranial defects. STUDY DESIGN Retrospective chart review. MATERIALS AND METHODS A retrospective chart review was performed of patients who underwent cranioplasty at a single institution between 1992 and 2012. The patients were divided based on whether bone autograft, demineralized bone matrix, or bone cement was used for reconstruction of their craniofacial defect. Demographics and diagnosis data were collected. Complications and cosmetic outcomes were examined for each group. RESULTS There was no significant difference between groups regarding follow-up and age at time of surgery. The bone cement group had a higher infection rate. There was more dehiscence and scalp scarring in the autograft and bone cement groups. However, residual bone defects and the need for a revision cranioplasty were higher in the bone matrix group. Likewise, patient, parent, and surgeon satisfaction with the appearance was lower in the bone matrix group. CONCLUSIONS There appears to be a trend toward a lower success rate in patients with fibroblast growth factor receptor-related craniosynostosis and in those reconstructed with bone matrix compared to bone autograft and bone cement. LEVEL OF EVIDENCE 4.