Clinical, Radiological, and Microbiological Profile of Patients with Autogenous Cranioplasty Infections

Bhaskar, Ivan Paul; Inglis, Timothy J. J.; Lee, Gabriel Y. F.

doi:10.1016/j.wneu.2013.01.013

Cited by 36 publications

(27 citation statements)

References 13 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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“…While it is proposed that subcutaneous pockets may provide a favorable vascularized environment, 9 some authors show that bone flaps are more susceptible to bone resorption and infection while subcutaneously stored. 10,11 There are conflicting data when comparing these two storage methods. Inamasu et al looked at a group of 70 patients of all ages and found no significant statistical difference between outcomes for subcutaneous bone storage and cryopreservation, except in cases of traumatic brain injury, where cryopreservation had a much higher rate of surgical site infection.…”

mentioning

confidence: 99%

Cranioplasty for Large-Sized Calvarial Defects in the Pediatric Population: A Review

Lam

Kuether

Fong

et al. 2015

Craniomaxillofacial Trauma & Reconstruction

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Large-sized cranial defects can arise from many etiologies, including open skull trauma, infection, tumor, and craniofacial reconstruction complications. With advances in neurotrauma care and early surgical decompression, trauma outcomes have improved over time; survivors are left with cranial defects. While large retrospective studies and metaanalyses of adult cranioplasty have been conducted, less is known about outcomes in the pediatric population.Reimplantation of the autologous bone flaps in children is thought to be advantageous. The osseous material can become reincorporated over the process of a child's maturation and growth. However, bone resorption is seen in up to 50% in the pediatric population 1,2 compared with up to 6.5% in adults, 3 necessitating further reconstructive surgery either with further autologous materials (split-thickness cranial bone graft, particulate bone graft with or without resorbable mesh), or other alloplastic materials (methyl methacrylate, hydroxyapatite cement, demineralized bone, and titanium mesh). We review the literature on special considerations, materials, and outcomes of large-sized cranioplasty in children such as after decompressive craniectomy (►Table 1). Autologous ReconstructionAutologous cranioplasty after decompressive craniectomy is considered the gold standard in pediatric care because of the ability of the bone graft to reincorporate into the skull (osseointegration), lower risk of material rejection, and ability to allow growth of the skull. There are several approaches to this form of reconstruction (►Table 2). The three main ways to perform an autologous cranioplasty use bone stored in the body, cryopreserved bone, or bone flaps harvested from a donor site. With pediatric patients, additional considerations must account for the high incidence of bone resorption (►Fig. 1a-c), the immature osseous skeleton, and future growth. Bone Flap Storage MethodsMethods of bone preservation each have advantages and drawbacks. Cryopreservation of the bone flap obviates a second surgical site and is favored by most of the U.S. centers. However, cryopreservation requires facilities for bone storage; in cases of geographic transfer of patient care, logistics of transport pose additional difficulty.4 In addition, the freezing process can devitalize the bone and result in an increased rate of complications including infection, resorption, and cosmetic deformity. AbstractLarge-sized calvarial defects in pediatric patients pose a reconstructive challenge because of children's unique physiology, developing anatomy, and dynamic growth. We review the current literature and outcomes with autologous and alloplastic cranioplasty in the pediatric population.

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“…Fever, scalp swelling and local inflammations were presented. Imaging study shows extra-axial fluid collection, subgaleal fluid collection, galea swelling, cerebritis, osteomyelitis, and so on 6). In bone flap culture during surgery, primary skin flora such as P. acnes, coagulase-negative staphylococci and S. aureus were cultured 13).…”

Section: Complications After Cranioplastymentioning

confidence: 99%

Review of Cranioplasty after Decompressive Craniectomy

Cho

Kang

2017

Korean J Neurotrauma

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Cranioplasty is an in evitable operation conducted after decompressive craniectomy (DC). The primary goals of cranioplasty after DC are to protect the brain, achieve a natural appearance and prevent sinking skin flap syndrome (or syndrome of the trephined). Furthermore, restoring patients' functional outcome and supplementing external defects helps patients improve their self-esteem. Although early cranioplasty is preferred in recent year, optimal timing for cranioplasty remains a controversial topic. Autologous bone flaps are the most ideal substitute for cranioplasty. Complications associated with cranioplasty are also variable, however, post-surgical infection is most common. Many new materials and techniques for cranioplasty are introduced. Cost-benefit analysis of these new materials and techniques can result in different outcomes from different healthcare systems.

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Clinical, Radiological, and Microbiological Profile of Patients with Autogenous Cranioplasty Infections

Cited by 36 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

Cranioplasty for Large-Sized Calvarial Defects in the Pediatric Population: A Review

Review of Cranioplasty after Decompressive Craniectomy

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