Comparison of Complications Following Cranioplasty Using a Sterilized Autologous Bone Flap or Polymethyl Methacrylate

Abstract

ObjectiveThe aims of current study are to compare complications following cranioplasty (CP) using either sterilized autologous bone or polymethyl methacrylate (PMMA), and to identify the risk factors for two of the most common complications: bone flap resorption (BFR) and surgical site infection (SSI).MethodsBetween January 2004 and December 2013, 127 patients underwent CP and were followed at least 12 months. Variables, including sex, age, initial diagnosis, time interval between decompressive craniectomy (DC) and CP, operation time, size of bone flap, and presence of ventriculo-peritoneal shunt, were analyzed to identify the risk factors for BFR and SSI.ResultsA total of 97 (76.4%) patients underwent CP using PMMA (Group I) and 30 (23.6%) underwent CP using autologous bone (Group II). SSI occurred in 8 (8.2%) patients in Group I, and in 2 (6.7%) in Group II; there was no statistically significant difference between the groups (p=1.00). No statistically significant risk factors for SSI were found in either group. In Group I, there was no reported case of BFR. In Group II patients, BFR developed in 18 (60.0%) patients at the time of CP (Type 1 BFR), and at 12-month follow up (Type 2 BFR) in 4 (13.3%) patients. No statistically significant risk factors for BFR were found in Group II.ConclusionCP using sterilized autologous bone result in a significant rate of BFR. PMMA, however, is a safe alloplastic material for CP, as it has low complication rate.

Labial repositioning using polymethylmethracylate (PMMA)-based cement for esthetic smile rehabilitation—A case report

“…PMMA properties, such as inertness, low cost, rigidity, easy preparation, biocompatibility etc. , make PMMA-based bone cements suitable for use in different health-related situations, body areas and procedures, such as in cranioplasty, in which it has been used since the second world war [ [12] , [13] , [14] ]. PMMA has been the most widely used material for correction of bony defects of the skull and face, mainly for cosmetic reasons [ 14 ].…”

“…Among the complications associated with PMMA, the long-term infection rate was 13.9% in the study by Kim et al [ 18 ] Cheng et al [ 19 ] detected approximately 6.25% of infections in their patients. Kumar et al [ 20 ], however, found no complications in any of their 15 patients, a result similar to that of Rotaru et al [ 21 ], where none of the patients presented complications.…”

A Prospective Comparative Study of Different Methods of Cranioplasty: Our Institutional Experience

“…Tokoro et al 7 and Marcek et al 3 found that longer operative time was a significant risk factor for surgical site infection, but no such association was seen in our study (►Table 6), which is similar to the findings of the study published by Kim et al 15 and Lee et al 16 In the study by Kim et al, bone flap resorption occurred significantly more in patients who underwent decompressive craniectomy due to traumatic brain injury (8.5%) than due to any other primary diagnosis, while in our study, bone flap resorption was seen in 7.8% of patients when the initial diagnosis was intracranial hematoma due to TBI (►Table 4).…”

“…In the study conducted by Kim et al, 7 the researchers compared complications following different methods of cranioplasty in 97 patients who underwent cranioplasty. The overall infection rate was 7.9% and the infection rate of the group that underwent sterilized autologous bone cranioplasty was 6.7%.…”

A Comparison between Pediatric and Adult Patients after Cranioplasty: Aseptic Bone Resorption Causes Earlier Revision in Children

“…Previous studies did not find any differences in infection rates comparing autologous bone flaps with synthetic materials. [4][5][6] Although the reimplantation of the autologous bone flap has the advantage of considerably lower costs over synthetic materials, it is associated with a relatively high risk of aseptic bone resorption (ABR) that leads to a considerable number of patients requiring further surgery. 7,8 Some risk factors leading to ABR have been discussed including young age, bone flap fragmentation, or shuntdependent hydrocephalus.…”