Serlo W, MD, PhD; Ashammakhi N, MBBCh, FRCSEd, PhD; Törmälä P, PhD, MDhC; Waris T, MD, PhD

We report a new method of cranial bone osteofixation using novel absorbable tacks and plates instead of screws and plates in order to reduce operative time and consequently the costs of surgical care.

A 36-year-old man presented for elective cranioplasty to reconstruct a large frontal cranial bone defect that followed a decompression operation performed because of head injury sustained six months previously.

Cranioplasty was performed using split parietal bone grafts to reconstruct the defect. Bone grafts were fixed together and to the skull, using self-reinforced poly(L/DL)lactide [SR-P(L/DL)LA] (70/30) (Biosorb FX) plates (n=10) and novel tacks (n=98). The plates were of 0.6 mm thickness, 102 mm length and 12 mm breadth. The tacks had a maximum thread diameter of 2 mm and a length of 6 mm. The tacks used did not require any tapping procedure and they were applied using a special applicator gun.

Stable and secure fixation was obtained intra-operatively. The postoperative period was uneventful except for delayed epithelialization of a small area (1 x 0.5 cm) over the frontal skin that healed later. One year postoperatively, the cosmetic result was excellent and no complications were detected.

Stabilization of large cranial bone pieces can be achieved using bioabsorbable SR-PLDLA plates and tacks, with excellent cosmetic results. The method is thought to be reliable and may save time.

Key words: Bioabsorbable, Cranioplasty, Plate, Polylactide, Tacks.