Analyses of the factors influencing bone graft infection after delayed cranioplasty

Matsuno, Akira; Tanaka, Haruyuki; Iwamuro, Hirokazu; Takanashi, Shigehiko; Miyawaki, Satoru; Nakashima, Mitsuyoshi; Nakaguchi, Hiroshi; Nagashima, Tadashi

doi:10.1007/s00701-006-0740-6

Cited by 272 publications

(227 citation statements)

References 36 publications

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“…We found no significant association of age, sex, DM, and mechanism of injury (SAH, trauma, ischemic stroke) with postcranioplasty infection, which is consistent with the published literature. 22,29 Reoperation for hematoma showed no significant effect in our study, even though the need for multiple procedures has been shown to increase the risk of cranioplasty site infection. 29,43,47 On the other hand, Cheng et al's work 9 showed that the number of procedures does not affect the risk of graft infection following cranioplasty.…”

Section: Timing Infection and Hydrocephaluscontrasting

confidence: 56%

Complications following cranioplasty: incidence and predictors in 348 cases

Zanaty

Chalouhi

Starke

et al. 2015

JNS

193

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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Section: Timing Infection and Hydrocephaluscontrasting

confidence: 56%

Complications following cranioplasty: incidence and predictors in 348 cases

Zanaty

Chalouhi

Starke

et al. 2015

JNS

193

165

View full text Add to dashboard Cite

show abstract

“…17 However, other data suggest that an increased interval increases both the incidence of complications and the risk of flap contamination. 5,11,13 A systematic review of adult cranioplasty showed no effect of timing on the rate of complications. 20 Likewise, our analysis revealed only 1 study in which the timing of cranioplasty was found to be associated with the risk of complications, along with several that showed no such association.…”

Section: Timing Of Cranioplastymentioning

confidence: 99%

Outcomes of cranioplasty following decompressive craniectomy in the pediatric population

Rocque

Amancherla

Lew

et al. 2013

PED

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Cranioplasty is routinely performed following decompressive craniectomy in both adult and pediatric populations. In adults, this procedure is associated with higher rates of complications than is elective cranial surgery. This study is a review of the literature describing risk factors for complications after cranioplasty surgery in pediatric patients. A systematic search of PubMed, Cochrane, and SCOPUS databases was undertaken. Articles were selected based on their titles and abstracts. Only studies that focused on a pediatric population were included; case reports were excluded. Studies in which the authors assessed bone flap storage method, timing of cranioplasty, material used (synthetic vs autogenous), skull defect size, and/or complication rates (bone resorption and surgical site infection) were selected for further analysis. Eleven studies that included a total of 441 cranioplasties performed in the pediatric population are included in this review. The findings are as follows: 1) Based on analysis of pooled data, using cryopreserved bone flaps during cranioplasty may lead to a higher rate of bone resorption and lower rate of infection than using bone flaps stored at room temperature. 2) In 3 of 4 articles describing the effect of time between craniectomy and cranioplasty on complication rate, the authors found no significant effect, while in 1 the authors found that the incidence of bone resorption was significantly lower in children who had undergone early cranioplasty. Pooling of data was not possible for this analysis. 3) There are insufficient data to assess the effect of cranioplasty material on complication rate when considering only cranioplasties performed to repair decompressive craniectomy defects. However, when considering cranioplasties performed for any indication, those in which freshly harvested autograft is used may have a lower rate of resorption than those in which stored autograft is used. 4) There is no appreciable effect of craniectomy defect size or patient age on complication rate. There is a paucity of articles describing outcomes and complications following cranioplasty in children and adolescents. However, based on the studies examined in this systematic review, there are reasons to suspect that method of flap preservation, timing of surgery, and material used may be significant. Larger prospective and retrospective studies are needed to shed more light on this important issue.

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“…Bone flap/graft resorption and infection [8,9], donor site morbidity, inadequate quantity of graft harvestable to bridge large cranial defects, prolonged intra-operative time, intraoperative blood loss and requirement of transfusions, need for surgical expertise and delayed post operative recovery [10] are definite drawbacks of autografting. Advanced age, presence of comorbidities, poor general condition of the patient, difficulties with bone flap storage, acute case scenarios and anatomical constraints can lead to difficulty in autografting or to the loss of the excised bone flap in a large number of cases [11,12]. At times, complications may result following Autogenous bone grafting, such as surgical site infection (SSI), graft/bone flap exposure, resorption, migration, hematomas and seromas [13].…”

Section: Introductionmentioning

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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Analyses of the factors influencing bone graft infection after delayed cranioplasty

Abstract: Autoclaved and autogenous bone grafts and PMMA have a significantly higher rate of graft infection. Titanium mesh has the significantly lowest rate of graft infection.

Cited by 272 publications

References 36 publications

Complications following cranioplasty: incidence and predictors in 348 cases

Complications following cranioplasty: incidence and predictors in 348 cases

Outcomes of cranioplasty following decompressive craniectomy in the pediatric population

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

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