Analysis of the factors affecting graft infection after cranioplasty

Kim, Hoon; Sung, Seng Oun; Kim, Sung Jun; Kim, Seong-Rim; Park, Ik-Seong; Jo, Kwang Wook

doi:10.1007/s00701-013-1877-8

Cited by 72 publications

(40 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We found no significant association of age, sex, DM, and mechanism of injury (SAH, trauma, ischemic stroke) with postcranioplasty infection, which is consistent with the published literature. 22,29 Reoperation for hematoma showed no significant effect in our study, even though the need for multiple procedures has been shown to increase the risk of cranioplasty site infection. 29,43,47 On the other hand, Cheng et al's work 9 showed that the number of procedures does not affect the risk of graft infection following cranioplasty.…”

Section: Timing Infection and Hydrocephaluscontrasting

confidence: 61%

Complications following cranioplasty: incidence and predictors in 348 cases

Zanaty

Chalouhi

Starke

et al. 2015

JNS

200

165

View full text Add to dashboard Cite

C ranioplasty is more than a cosmetic repair of cranial defects; it is part of the rehabilitation process following a patient's neurological injury. Recent studies have shown that cranioplasty may improve the patient's psychological status, social performance, and neurocognitive functioning. 1,14,19,21 The factors that contribute to periprocedural complications, including patients' demographic information, comorbidities, surgical procedure, and under lying disease, need to be thoroughly evaluated. Previous studies that were intended to answer these questions were limited by their design or by their sample size. Our aim was to evaluate risk factors that predispose patients to an increased risk of cranioplasty complications. Recent evidence in the literature emphasizes patient-specific factors over surgery-specific factors as major predictors of cranioplasty complications. 47,51 It is also becoming evident that surgical treatment for cranioplasty complications is associated with additional surgical procedures. 17,46 In this study, we evaluated the association between patient-specific factors and complications folabbreviatioNs AED = antiepileptic drug; DHC = decompressive hemicraniectomy; DM = diabetes mellitus; SAH = subarachnoid hemorrhage; TBI = traumatic brain injury. obJect The factors that contribute to periprocedural complications following cranioplasty, including patient-specific and surgery-specific factors, need to be thoroughly assessed. The aim of this study was to evaluate risk factors that predispose patients to an increased risk of cranioplasty complications and death. methods The authors conducted a retrospective review of all patients at their institution who underwent cranioplasty following craniectomy for stroke, subarachnoid hemorrhage, epidural hematoma, subdural hematoma, and trauma between January 2000 and December 2011. The following predictors were tested: age, sex, race, diabetic status, hypertensive status, tobacco use, reason for craniectomy, urgency status of the craniectomy, graft material, and location of cranioplasty. The cranioplasty complications included reoperation for hematoma, hydrocephalus postcranioplasty, postcranioplasty seizures, and cranioplasty graft infection. A multivariate logistic regression analysis was performed. Confidence intervals were calculated as the 95% CI. results Three hundred forty-eight patients were included in the study. The overall complication rate was 31.32% (109 of 348). The mortality rate was 3.16%. Predictors of overall complications in multivariate analysis were hypertension (OR 1.92, CI 1.22-3.02), increasing age (OR 1.02, CI 1.00-1.04), and hemorrhagic stroke (OR 3.84,). Predictors of mortality in multivariate analysis were diabetes mellitus (OR 7.56, CI 1.56-36.58), seizures (OR 7.25, CI 1.238-42.79), bifrontal cranioplasty (OR 5.40,, and repeated surgery for hematoma evacuation (OR 13.00, CI 1.51-112.02). Multivariate analysis was also applied to identify the variables that affect the development of seizures, the need for reoperation for hem...

show abstract

Section: Timing Infection and Hydrocephaluscontrasting

confidence: 61%

Complications following cranioplasty: incidence and predictors in 348 cases

Zanaty

Chalouhi

Starke

et al. 2015

JNS

200

165

View full text Add to dashboard Cite

show abstract

“…Although autografting, that is, either reimplantation of the excised bone flap [6,7], or transfer of cortical, cancellous or corticocancellous bone from any anatomic site to the defect site in the same subject, is obviously the best choice owing to the lack of immune or foreign body reactions, absence of a risk of transmission of disease, and the potential of the graft to be incorporated as biologically active and dynamic living tissue it has certain inherent limitations and disadvantages. Bone flap/graft resorption and infection [8,9], donor site morbidity, inadequate quantity of graft harvestable to bridge large cranial defects, prolonged intra-operative time, intraoperative blood loss and requirement of transfusions, need for surgical expertise and delayed post operative recovery [10] are definite drawbacks of autografting. Advanced age, presence of comorbidities, poor general condition of the patient, difficulties with bone flap storage, acute case scenarios and anatomical constraints can lead to difficulty in autografting or to the loss of the excised bone flap in a large number of cases [11,12].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Versatility of the 3-D Titanium Mesh Implant in the Closure of Large Post-Craniectomy Osseous Defects, and its Therapeutic Role in Reversing the Syndrome of the Trephined: Clinical Study of a Case Series and Review of Literature

Jeyaraj

2015

J. Maxillofac. Oral Surg.

View full text Add to dashboard Cite

“…These cranioplasty applications have complications such as implant failure, infection, skin problems, migration of reconstruction material, sinking flap syndrome, subdural and subgaleal fluid collection, and hydrocephalus [12-18]. Studies have shown that the type of material applied does not change infection rates much, but that the increase in the number of operations increases infection rates [4, 13, 15]. Primary bone fragment replacement via single-session operation also prevents this increase in infection rates and avoids the placement of a foreign material in the skull.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Primary Bone Fragment Replacement in Pediatric Patients with Depressed Skull Fracture

et al. 2019

View full text Add to dashboard Cite

Objective: To evaluate pediatric patients who were operated with the diagnosis of depressed skull fracture. Methods: The records of pediatric patients who presented with traumatic head injury to multicenter neurosurgery clinics between 2002 and 2018 and who were operated with a diagnosis of depressed skull fracture were retrospectively reviewed. All of the patients underwent primary bone fragment replacement operation, and the patients’ own bone flaps were used to repair depressed skull fractures in all of them. Results: A total of 78 patients were included in the study. Of the study group, 20 patients presented with mild head injury, 37 had moderate head injury, and 21 had severe head injury. Dural injury was present in 67 patients (86%) and the dura was intact in 11 patients (14%). After surgery, 63 patients (81%) had good outcome, 8 patients (10%) had moderate disability, and 5 patients (6.5%) had severe disability. Two patients with multiple accompanying cranial pathologies died and the mortality rate was 2.5%. Infection was detected in only 2 of the 78 patients who were treated within the first 72 h after trauma. One of them had meningitis and the other skin infection. Both patients were treated with appropriate antibiotherapy. None of the patients in the study group had an infection involving the bone, such as osteomyelitis, or the tissues under the bone, such as subdural-epidural empyema or abscess. None of the patients required reoperation and removal of the bone. Conclusion: In the present study, as the pathologies accompanying the depressed skull fractures of the patients increased, Glasgow Coma Scale scores at arrival and Glasgow Outcome Scale scores at discharge decreased. Regardless of whether the depressed fracture is simple or compound, primary bone fragment replacement with appropriate decontamination of the fractured bone and operation area via single-session intervention gives good results. It is important to perform the surgery as soon as possible to reduce the risk of contamination. Primary bone fragment replacement seems to be an appropriate treatment option for depressed skull fractures.

show abstract

Analysis of the factors affecting graft infection after cranioplasty

Cited by 72 publications

References 16 publications

Complications following cranioplasty: incidence and predictors in 348 cases

Complications following cranioplasty: incidence and predictors in 348 cases

Efficacy and Versatility of the 3-D Titanium Mesh Implant in the Closure of Large Post-Craniectomy Osseous Defects, and its Therapeutic Role in Reversing the Syndrome of the Trephined: Clinical Study of a Case Series and Review of Literature

Outcome of Primary Bone Fragment Replacement in Pediatric Patients with Depressed Skull Fracture

Contact Info

Product

Resources

About