A simplified technique for polymethyl methacrylate cranioplasty: Combined cotton stacking and finger fracture method

Primary objective: Polymethyl methacrylate (PMMA) is one of the most frequently used cranioplasty materials. However, limitations exist with PMMA cranioplasty including longer operative time, greater blood loss and a higher infection rate. To reduce these disadvantages, it is proposed to introduce a new surgical method for PMMA cranioplasty. Research design: Retrospective review of nine patients who received nine PMMA implants using combined cotton stacking and finger fracture method from January 2008 to July 2011. Methods and procedures: The definitive height of skull defect was quantified by computer-based image analysis of computed tomography (CT) scans. Aesthetic outcomes as measured by postreduction radiographs and cranial index of symmetry (CIS), cranial nerve V and VII function and complications (wound infection, hardware extrusions, meningitis, osteomyelitis and brain abscess) were evaluated. Main outcomes and results: The mean operation time for implant moulding was 24.56 +/- 4.6 minutes and 178.0 +/- 53 minutes for skin-to-skin. Average blood loss was 169 mL. All post-operative radiographs revealed excellent reduction. The mean CIS score was 95.86 +/- 1.36%, indicating excellent symmetry. Conclusions: These results indicate the safety, practicability, excellent cosmesis, craniofacial symmetry and stability of this new surgical technique.