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Skull base surgery. 1995 April; 5(2): 109–116.
PMCID: PMC1661825

Reconstructing Complex Cranial Defects with a Preformed Cranial Prosthesis


Large cranial defects (70 cm2 or more) of complex geometric shapes (bifrontal or involving supraorbital ridges) that are associated with significant cutaneous contracture or soft tissue loss are challenging to reconstruct. We have treated 10 patients with complex cranial defects through a staged approach. Reconstructing the defect involved several steps. Before each surgery, we constructed a craniofacial prosthesis from polymethyl methacrylate to fit the patient's individual defect. When indicated, adjacent skin was expanded with a subcutaneous tissue expander. Finally, we carried out a cranioplasty and placed the prosthesis. Operative closure of the defect was facilitated by microplate and screw fixation with minimal prothesis contouring. Secure, vital, nontension skin closure was performed with the delayed, expanded local flap. Exposure to free polymer and exothermic reaction was avoided. Cosmetic results in these patients with high-volume, geometrically complex defects were excellent. No complications occurred, and the overall operative time was shortened.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Argenta LC. Controlled tissue expansion in reconstructive surgery. Br J Plast Surg. 1984 Oct;37(4):520–529. [PubMed]
  • Blatt IM, Failla A. Acrylic implants for frontal bone defects. Mil Med. 1972 Jan;137(1):22–25. [PubMed]
  • Cipcic JA. Symposium on synthetics in maxillofacial surgery. 3. Silicone implant correction of facial deformities. Laryngoscope. 1968 Apr;78(4):565–585. [PubMed]
  • Firtell DN, Moore DJ, Bartlett SO. A radiographic grid for contouring cranial prostheses. J Prosthet Dent. 1971 Apr;25(4):439–445. [PubMed]
  • Radovan C. Tissue expansion in soft-tissue reconstruction. Plast Reconstr Surg. 1984 Oct;74(4):482–492. [PubMed]

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