Analysis of the factors influencing bone graft infection after cranioplasty

Lee, Young Moo; Chung, Young Sub; Lee, Sang Hyung; Yang, Hee-Jong; Son, Young Hoon

doi:10.1097/ta.0b013e318256a150

Cited by 94 publications

(67 citation statements)

References 13 publications

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“…Although autografting, that is, either reimplantation of the excised bone flap [6,7], or transfer of cortical, cancellous or corticocancellous bone from any anatomic site to the defect site in the same subject, is obviously the best choice owing to the lack of immune or foreign body reactions, absence of a risk of transmission of disease, and the potential of the graft to be incorporated as biologically active and dynamic living tissue it has certain inherent limitations and disadvantages. 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].…”

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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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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“…17,38,42,48 Finally, recent studies, including a meta-analysis, have shown no difference in complication rates between early and late cranioplasties. 5,24,39,51 We did not account for the timing of cranioplasty in our study because our patients underwent early operation unless there was a convincing need to delay it, such as the presence of wound dehiscence, hydrocephalus, or evidence of persistent brain swelling. We balanced the wait for maximal neurological improvement with early intervention to prevent hemodynamic changes in the CSF and cerebral blood flow that may occur if the flap was left out for a prolonged period of time.…”

Section: Timing Infection and Hydrocephalusmentioning

confidence: 99%

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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“…• Increased Surgical Time [6,10,11] The literature suggests that increased surgical time dramatically increases the risk of infection. Longer surgical times (greater than 4 h) were associated with a higher risk of infection.…”

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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Analysis of the factors influencing bone graft infection after cranioplasty

Abstract: Prognostic/therapeutic study, level IV.

Cited by 94 publications

References 13 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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