Objective: To investigate the effect of the periosteum-preserving method on the bone healing rate after in situ replantation of autologous cranial bone flaps preserved in vivo.
Methods: A retrospective study was conducted on 99 patients who underwent autologous skull repair from January 2011 to December 2014. The 49 patients treated from January 2011 to December 2012 were divided into the nonperiosteum group, and the 51 patients treated from January 2013 to December 2014 were divided into the periosteum group. The autogenous cranial flaps of the two groups were preserved subcutaneously in vivo. Early in situ replantation was performed within 4-8 weeks after the operation. CT was performed regularly within 1, 6, 12, 24 and 60 months after the operation to observe the healing rate and bone resorption of the autogenous cranial flaps.
Results: At 1, 6, 12, 24 and 60 months after the operation, the skull healing rate in the periosteum group (0%, 41.176%, 74.510%, 100%, and 100%, respectively) was significantly higher than that in the nonperiosteum group (0%, 14.286%, 36.735%, 59.184%, and 75.510%, respectively). At 60 months after the operation, the bone resorption rate of 0% in the periosteum group was significantly lower than the 14.286% in the nonperiosteum group. The infection rate of 0% in the periosteum group was significantly lower than the 10.204% in the nonperiosteum group. The re-repair rate of 0% in the periosteum group was significantly lower than the 12.245% in the nonperiosteum group. There was no significant difference in the incidence of subcutaneous effusion between the periosteum group (5.882%) and the nonperiosteum group (6.122%).
Conclusion: Preservation of the periosteum and early in situ replantation of skull bone flaps preserved in vivo can increase the bone healing rate of the skull, reduce the infection rate, and reduce the probability of postoperative autogenous bone resorption.