Examining the Relationship Between Wound Complications and the Use of Resorbable Plates in Cranial Vault Reconstruction

Abstract

Background: Resorbable plates are commonly used in cranial vault reconstruction surgery. There are few published papers examining their safety profile. The authors examined the prevalence of wound complications associated with the use of resorbable plates (Inion CPS Fixation System) in pediatric patients undergoing cranial vault reconstruction. Methods: A retrospective review of patients (n ¼ 182) who underwent cranial vault reconstruction using resorbable plate fixation was undertaken. All procedures were performed by a single Craniofacial Surgeon at the National Pediatric Craniofacial Center from 2008 to 2016. Wound complications were identified from a prospectively maintained database and medical note review. Several key patient characteristics and surgical variables were also recorded and tested for associations with wound complications. Results: A total of 58.8% (107 of 182) of patients were male with a median age at surgery of 16.2 months. Overall, 12.1% (22 of 182) experienced a postoperative wound complication requiring hospital admission. A total of 2.73% (5 of 182) of the patients that returned to theatre had remnants of plates removed. The authors had a mean time from primary operation to secondary reoperation of 103 days. In univariate statistical analysis, females were more likely to develop a wound complication. However, in stratified analyses excluding patients with an underlying genetic syndrome, increasing age, and lower weight but not gender were associated with wound complications. Conclusions: A 12.1% (22 of 182) wound complication rate with the use of the Inion CPS Fixation System was observed. Inion plates appear to have an equivalent safety profile to other fixation devices. Increasing age and lower weight were associated with an increased risk of wound complications in nonsyndromic patients.

Discussion of Examining the Relationship Between Wound Complications and the Use of Resorbable Plates in Cranial Vault Reconstruction With Emphasis on Resorbable Polymer Chemistry and Structure

“…Reconstruction of the pediatric cranial vault lends itself particularly well to resorbable fixation due to the small loads incurred as well as avoidance of transcranial plate migration and growth restriction complications, becoming the standard of care. 3,4 The focus of Reilly et al 5 , was to retrospectively examine the rate of wound complications among 182 pediatric craniosynostosis patients, including 37 patients with a syndrome diagnosis. All patients underwent cranial vault reconstruction with resorbable plate and screw fixation provided by the Inion CPS Fixation System (Inion, Inc. Tampere, Finland).…”

“…1,2 One of the focal points of Reilly et al, was to discuss the chemical and structural aspects of various resorbable plating systems, including the one used in their study, to help interpret their results. 5 Although providing important insight, there were several limitations to that effort that deserve mention and clarification. First, the terms lactide, lactic acid, glycolide, and glycolic acid are used in different instances.…”

“…The focus of Reilly et al 5 , was to retrospectively examine the rate of wound complications among 182 pediatric craniosynostosis patients, including 37 patients with a syndrome diagnosis. All patients underwent cranial vault reconstruction with resorbable plate and screw fixation provided by the Inion CPS Fixation System (Inion, Inc. Tampere, Finland).…”