Autologous and Acrylic Cranioplasty: A Review of 10 Years and 258 Cases

Klinger, Daniel R.; Madden, Christopher J.; Beshay, Joseph E.; White, Jonathan A.; Gambrell, Kenneth; Rickert, Kim L.

doi:10.1016/j.wneu.2013.08.005

Cited by 118 publications

(96 citation statements)

References 19 publications

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“…Often, direct re-implantation of the autologous bone flap is not feasible and storage (either cryogenic or subcutaneous) is required to ensure the flap is preserved until re-implantation [21,68,69]. Whilst functional, these methods may not provide adequate storage, with infection and resorption potential rendering the autologous flap unusable [19,21,70].…”

Section: Discussionmentioning

confidence: 99%

“…As such, it can be considered to have a potential IMF and TAB value of 3, representing full integration and regeneration. However, literature highlights resorption of the autologous bone implant as a common issue known to impact the effectiveness of potential vascularization and reintegration [19,22], and as a result the autologous bone implant fails to reach the stage when reintegration is possible; shielded from the immune system it presents an ideal scaffold for bacteria and increasing risk of implant failure. As such, the IMF and TAB values, for the purposes of this study, can be considered as 0.…”

Section: Autologous Bonementioning

confidence: 99%

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Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

et al. 2017

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Background: Analysis of current literature highlights a wide variation in reported infection risk for different materials in cranial repair. The purpose of these composite materials are to mimic natural bone and assist in restoring function (structurally and aesthetically) to the human skull. This review aims to examine the meta-data in order to provide an amalgamated overview of potential trends between implant material, manufacturing method and infection risk, in order to provide a core reference point for future studies surrounding emerging biomedical materials in the fields of cranioplasty by providing base point for understanding the capabilities and limitations of current technologies. Methods: A search for articles was conducted, with the following criteria seen as fundamental in providing an accurate picture of the current landscape: publication in the last decade, provision of a numerical value for both number of implants and infection cases, patient sample of 10+, adult patients, and cranioplasty/cranial repair. Results: A total of 41 articles were seen to meet the author's inclusion criteria. Average infection rates per material ranged between 2.04% and 10.98%. The results indicate that there is variation between materials in regards to total infection risk, however, depending on the materials compared, this value may be insignificant. Alternative risk factors associated with infection, including surgical time, revisions and previous infection, have a greater impact on infection potential than material variation. Comparison of fabrication methods did highlight a notable effect on average infection rate. Trends can be observed showing that materials with greater levels of surface interaction and active support of tissue ingrowth presented greater infection resistance. Such characteristics are due to the physical structures of the implants. Conclusions: It can be said that the manufacturing methods can influence biomedical materials to assist in minimizing implant infection risk.

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Section: Discussionmentioning

confidence: 99%

Section: Autologous Bonementioning

confidence: 99%

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

et al. 2017

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“…Among traumatic brain injury patients, complex injuries and surgical involvement of the frontal sinus carried a significantly higher infection rate of 17% and 38.5%, respectively. 34 In this series, prior to cranioplasty all patients with an infection underwent a minimum 6-month quiescent period of no neurosurgical or cranioplasty related procedures.…”

Section: Discussionmentioning

confidence: 99%

Computed-tomography modeled polyether ether ketone (PEEK) implants in revision cranioplasty

O’Reilly

Barnett

Madden

et al. 2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…PMMA is associated with significant post-placement shrinkage. Other complications of PMMA cranioplasty include infection 30 and pulmonary embolism (due to PMMA extravasation into venous circulation). 31 Most importantly, PMMA lacks the osseointegrative and osteoinductive properties that would provide complete regeneration of reliable bone in a large cranial defect.…”

Section: Advances In Alloplastic Bone Substitutes For Cranial Repairmentioning

confidence: 99%

The Recent Revolution in the Design and Manufacture of Cranial Implants

et al. 2015

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Large format (i.e., > 25 cm2) cranioplasty is a challenging procedure not only from a cosmesis standpoint, but also in terms of ensuring that the patient's brain will be well-protected from direct trauma. Until recently, when a patient's own cranial flap was unavailable, these goals were unattainable. Recent advances in implant Computer Aided Design and 3-D printing are leveraging other advances in regenerative medicine. It is now possible to 3-D-print patient-specific implants from a variety of polymer, ceramic, or metal components. A skull template may be used to design the external shape of an implant that will become well integrated in the skull, while also providing beneficial distribution of mechanical force distribution in the event of trauma. Furthermore, an internal pore geometry can be utilized to facilitate the seeding of banked allograft cells. Implants may be cultured in a bioreactor along with recombinant growth factors to produce implants coated with bone progenitor cells and extracellular matrix that appear to the body as a graft, albeit a tissue-engineered graft. The growth factors would be left behind in the bioreactor and the graft would resorb as new host bone invades the space and is remodeled into strong bone. As we describe in this review, such advancements will lead to optimal replacement of cranial defects that are both patient-specific and regenerative.

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Autologous and Acrylic Cranioplasty: A Review of 10 Years and 258 Cases

Cited by 118 publications

References 19 publications

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

Cranioplasty and Craniofacial Reconstruction: A Review of Implant Material, Manufacturing Method and Infection Risk

Computed-tomography modeled polyether ether ketone (PEEK) implants in revision cranioplasty

The Recent Revolution in the Design and Manufacture of Cranial Implants

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