Acute autologous bone flap infection after cranioplasty for postinjury decompressive craniectomy

BackgroundRenewed interest has developed in decompressive craniectomy, and improved survival is shown when this treatment is used after malignant middle cerebral artery infarction. The aim of this study was to investigate the frequency and possible risk factors for developing surgical site infection (SSI) after delayed cranioplasty using autologous, cryopreserved bone.MethodsThis retrospective study included 74 consecutive patients treated with decompressive craniectomy during the time period May 1998 to October 2010 for various non-traumatic conditions causing increased intracranial pressure due to brain swelling. Complications were registered and patient data was analyzed in a search for predictive factors.ResultsFifty out of the 74 patients (67.6 %) survived and underwent delayed cranioplasty. Of these, 47 were eligible for analysis. Six patients (12.8 %) developed SSI following the replacement of autologous cryopreserved bone, whereas bone resorption occurred in two patients (4.3 %). No factors predicted a statistically significant rate of SSI, however, prolonged procedural time and cardiovascular comorbidity tended to increase the risk of SSI.ConclusionsSSI and bone flap resorption are the most frequent complications associated with the reimplantation of autologous cryopreserved bone after decompressive craniectomy. Prolonged procedural time and cardiovascular comorbidity tend to increase the risk of SSI.

show abstract

“…The infection rate varies between studies, from 0 to 25.9 % with an average of 7.7 % (Table 2) [2, 7, 19, 24–26, 32, 34–37, 42, 53]. …”

Section: Discussionmentioning

confidence: 99%

Cranioplasty with autologous cryopreserved bone after decompressive craniectomy. Complications and risk factors for developing surgical site infection

Sundseth

Berg-Johnsen

et al. 2014

Acta Neurochir

View full text Add to dashboard Cite

show abstract

“…Âge, sexe masculin [14][15][16] ASA 2 [17] Diabète et glycémie préopératoire élevée [11] Alcoolisme [11] Insuffisance respiratoire en postopératoire [5,18] Présence d'une collection sous-galéale préopératoire [9] Facteurs de risque liés à la prise en charge d'une néoplasie intracrânienne active Radiothérapie préalable à la chirurgie [19] Chimiotherapie intraopératorie tel que l'implant de wafers de carmustine (Gliadel 1 ) [20] Facteurs de risque liés à la préparation du patient et à la période péri-opératoire Rasage [21,22] Asepsie cutanée [11,[23][24][25] Absence d'antibioprophylaxie [7] Dysfonction du drainage postopératoire [7] Drainage CSF (cerebrospinal fluid) [5] Facteurs de risque liés à l'acte chirurgical Type de chirurgie (implant, ouverture sinusale, fuite de LCR) [2,4,5,18,26] Ré-intervention, notamment dans le mois qui suit [2,27,28] Durée de l'intervention (notamment > 4 h) [2,[4][5][6]18] Chirurgie réalisée en urgence [2,18] Résection du muscle temporal (ce qui diminue la vascularisation locale) [18] Volume de perte de sang [11] Monitorage de la pression intracranienne > 5 jours [18,29,30] Facteurs de risque liés à la conservation du volet crânien lors d'une repose en 2 temps Cryoconservation …”

Section: Facteurs De Risque Liés Aux Patientsunclassified

“…Des auteurs ont proposé de remettre en place le volet infecté après désin-fection, et de recourir à une irrigation postopératoire du volet par solutions antibiotiques [49] mais cette attitude n'a pas été évaluée. Si une cranioplastie est nécessaire dans le même temps, la mise en place de grilles en titane [50], qui offre le meilleur compromis entre sa malléabilité, sa solidité et sa résistance à la colonisation bactérienne [7,8,51] peut être proposée (Fig. 4).…”

Section: Diagnosticunclassified

Facteurs de risque, diagnostic et prise en charge de l’ostéite du volet crânien après craniectomie

Adélaïde

Signorelli

Valour

et al. 2014

Journal des Anti-infectieux

View full text Add to dashboard Cite

“…Reimplantation of the autologous bone flap may be preferable but, in cases of initially discarded bone flaps or secondary removal due to bone graft infection, customized computer-aided designed (CAD) cranioplasty implants are necessary. [3] Since firearms cause 35% of traumatic brain injury (TBI)-related deaths among US civilians and more than 50% of combat casualties in modern warfare among US service personnel result from head injuries, the resistance of cranioplasty implants to firearms is an issue of importance. [212]…”

Section: Introductionmentioning

confidence: 99%

Ballistics for neurosurgeons: Effects of firearms of customized cranioplasty implants

Lemcke

Löser²,

Telm³

et al. 2013

Surg Neurol Int

View full text Add to dashboard Cite

Introduction:There are about 33,000 deaths caused by gunshot wounds in the USA each year. Probably half of these deaths result from head wounds. Among US Army soldiers, 17% of all ballistic injuries are head wounds. This means that, even in those protected by ballistic helmets, gunshot injuries to the head represent a danger. The aim of this study was to examine the effects of shelling of computer-aided designed (CAD) cranioplasty implants made of two different materials.Methods:An experimental model was developed in an indoor gun range. CAD cranioplasties with a material thickness of 2-6 mm, made of titanium or PEEK-OPTIMA® were fixed in a watermelon and shot at with a .222 Remington rifle at a distance of 30 m distance, a .30-06 Springfield rifle at a distance of 30 m, a Luger 9 mm pistol at a distance of 8 m, or a .375 Magnum revolver at a distance of 8 m. The CAD cranioplasties were subsequently inspected for ballistic effects by a neurosurgeon.Results:Titanium CAD cranioplasty implants resisted shots from the 9 mm Luger pistol and were penetrated by both the .222 Remington and the .30-06 Springfield rifle. Shooting with the .357 Magnum revolver resulted in the titanium implant bursting. PEEK-OPTIMA® implants did not resist bullets shot from any weapon. The implants burst on shooting with the 9 mm Luger pistol, the .222 Remington, the .30-06 Springfield rifle, and the .357 Magnum revolver.Conclusions:Titanium CAD cranioplasty implants may offer protection from ballistic injuries caused by small caliber weapons fired at short distances. This could provide a life-saving advantage in civilian as well as military combat situations.

show abstract

Acute autologous bone flap infection after cranioplasty for postinjury decompressive craniectomy

Cited by 34 publications

References 8 publications

Cranioplasty with autologous cryopreserved bone after decompressive craniectomy. Complications and risk factors for developing surgical site infection

Cranioplasty with autologous cryopreserved bone after decompressive craniectomy. Complications and risk factors for developing surgical site infection

Facteurs de risque, diagnostic et prise en charge de l’ostéite du volet crânien après craniectomie

Ballistics for neurosurgeons: Effects of firearms of customized cranioplasty implants

Contact Info

Product

Resources

About