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Augmentation of the outer contours of the skull, commonly referred to as cranioplasty, has been done using a wide variety of biomaterials. The different types of materials used speaks to the great tolerance of this body area to implants in general and is the result of the superb blood supply of the scalp and skull tissues.

In many cranioplasties where large surface areas are being covered with some reasonable implant thickness, a custom 3D skull implant is always the best way to do it. But some cranioplasties are smaller in size or some custom implants may need a little ‘touchup’ with a little extra augmentation over a limited area of its surface. As a result it is more convenient to use an off-the-shelf implant product to do so. To be effective the implant material must be easily shaped, amenable to being inserted through small incisions and ideally allow some tissue attachment to it.

I have found that the use of ePTFE (expanded polytetrafluroethtylene, historically known as Gore-tex) to be good material for small aesthetic cranioplasty procedures. Available in large sheets up to 4mms in thickness it can easily be cut into any geometric shape. The edges can be crimped with an instrument and perfusion holes can be placed through it using a dermal punch. While flexible it is has enough structural integrity that allows it to be inserted through smaller incisions without being unduly folded or bent. Once inserted an instrument is used ti ensure that all parts of the implant are laying completely flat without edge irregularities.

One of ePTFE’s most interesting features is its microporous surface texture which comes from its expanded microfibrillar structure. This allows the surrounding soft tissues to grow onto and attach to it. Despite its smooth and slick appearing surface, tissues readily become lightly fixed to it.

Dr. Barry Eppley

Indianapolis Indiana

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