Factors affecting graft infection after cranioplasty

Cheng, Yufang; Weng, Hsu–Huei; Yang, Jen-Tsung; Lee, Ming-Hsueh; Wang, Ting‐Chung; Chang, Chen-Nen

doi:10.1016/j.jocn.2007.09.022

Cited by 171 publications

(125 citation statements)

References 17 publications

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“…Studies have also documented that the longer the delay in cranioplasty, the greater are the chances of autogenous bone flap resorption as well as SSI following cranioplasty [24,25]. Some data suggest that following DC, a good option would be to consider different alloplastic solutions for the repair, instead of the replacement of the patient's autogenous flap [26,27], and that the use of a Titanium mesh carries the lowest risk of infection [27], which makes sense because the patient's bone is a pabulum for bacteria (being devitalized but organic) [27], whereas Titanium is not. In the fourth patient of the case series presented, the epidural collection which developed beneath the re-implanted bone flap could not be aspirated without removing the flap altogether.…”

Section: Discussionmentioning

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.

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Section: Discussionmentioning

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.

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“…4,11 Some studies have shown that patients who had early cranioplasties had better functional outcomes, 3,5,46 whereas several others have shown that early cranioplasty (3-6 months) is associated with higher complication rates and worse outcomes, 3,4,[8][9][10]26,35,42 including hydrocephalus, increased intracranial pressure, and infection. Other studies have shown that late cranioplasty is associated with a higher risk of complications.…”

Section: Timing Infection and Hydrocephalusmentioning

confidence: 99%

Complications following cranioplasty: incidence and predictors in 348 cases

Zanaty

Chalouhi

Starke

et al. 2015

JNS

200

165

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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...

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“…• Latency Period between Tissue Removal and Implant [1,8] The literature suggests that a necessary latency period, from initial flap removal to implantation of the desired implant, may lead to a lower infection risk.…”

Section: Discussionmentioning

confidence: 99%

“…• Previous Multiple Operations/Recent Operation [1,9] The literature suggests that a higher number of operations can lead to a higher risk of infection. Additionally, short timeframes between surgeries are considered to further increase infection risk.…”

Section: Discussionmentioning

confidence: 99%

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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Factors affecting graft infection after cranioplasty

Cited by 171 publications

References 17 publications

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

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

Complications following cranioplasty: incidence and predictors in 348 cases

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

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