Titanium Clamps for a Simple Low-Profile Autologous Osteosynthesis in the Reconstruction of Posttraumatic Craniofacial Convexital Skeletal Disruption

Abstract

Attempts at reconstruction of posttraumatic craniofacial defects (PTCDs) can be a challenge in low-resource practice areas of the world where the needed biomaterials are logistically beyond reach. A simple low-profile technique of autologous osteosynthesis for PTCD using the titanium clamps is presented in this report. In addition, a 6-year prospective database on a consecutive cohort of patients who underwent this procedure was analyzed for clinical, functional, and aesthetic outcomes, both in-hospital and at midterm follow-up. The clinical data of 18 patients, all males, mean age 31.3 years (standard deviation, 9.7), were analyzed. Road traffic accidents (RTAs) were the cause of trauma in 14 of 18 patients (78%) and motorcycle crash, none helmeted, in 10 of the 18 patients (71% of RTAs). Out of 18 cases, 17 were open fractures; 89% suffered mild head injury, and associated brain injury on CT scan included pneumocephalus in 6 (5 of them significant); acute extradural hematoma in 4 and subdural in 2, and brain contusions in 9. The surgery was successful in all the cases: operative time <3 hours in 10 cases (56%), the in-hospital outcome was good in 95%. The median follow-up time was 24 months, in 6 of the 18 cases for ≥36 months. There was no case of surgical site infection in the perioperative or the follow-up period to date. The aesthetic outcome was also acceptable. This surgical technique for the reconstruction of PTCD appears effectual. Although its low cost makes it very attractive therein, it appears to be actually also recommendable even outside the low-resource developing countries.