Biomechanical evaluation of cranial flap fixation techniques: comparative experimental study of suture, stainless steel wire, and rivetlike titanium clamp.

OBJECTIVE: To study the techniques of cranial flap fixation (suture, stainless steel wire, and rivetlike titanium clamp) on biomechanics.
METHODS: Twenty-four cadaver craniotomy flaps were reattached with either suture, stainless steel wire, or rivetlike titanium clamp. Cranial flap fixation was timed and measured for the offset between cranial flap with craniotomy skull for every fixation technique. Load-bearing tests were performed by applying an external force until the failure of the fixation system.
RESULTS: Rivetlike titanium clamp required significantly less time to fix (94 +/- 13 seconds) than either suture (172 +/- 14 seconds) or stainless steel wire (399 +/- 45 seconds). The offset of cranial flap after rivetlike titanium clamp fixation (0.20 +/- 0.12 mm) was significantly smaller than either suture (2.20 +/- 0.24 mm) or stainless steel wire (1.32 +/- 0.34 mm). Rivetlike titanium clamp was also stronger than suture and stainless steel wire in the load-bearing test.
CONCLUSION: Rivetlike titanium clamp is easy to use, requires less time consumption, and shows accuracy and strength.