Comparison of acrylic and titanium cranioplasty<sup>#</sup>

Al‐Tamimi, Yahia; Sinha, Priyank; Trivedi, Mili; Robson, Craig; Al-Musawi, Tamara A; Hossain, Naveed; Mumford, Christopher; Towns, Gerry

doi:10.3109/02688697.2011.633640

Cited by 50 publications

(49 citation statements)

References 21 publications

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“…Infection rates of 5% to 20% are particularly elevated in the setting of frontal cranioplasty given sinus communication, risk for infection, and possible fistulization. 2,13,26,52,73,76,93 Complication rates quoted within the pediatric population reach as high as 23%, as reported by Blum et al in their 15-year retrospective review of 75 patients, with those patients with large defects, involvement of the frontal sinus, and any history of prior infection at the greatest risk. 13 Other rare but notable side effects of the material include delayed-type hypersensitivity reactions, which are seen in approximately 1% of patients.…”

Section: Acrylicsmentioning

confidence: 48%

Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends

Feroze

Walmsley

Choudhri

et al. 2015

JNS

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Cranial bone repair is one of the oldest neurosurgical practices. Reconstructing the natural contours of the skull has challenged the ingenuity of surgeons from antiquity to the present day. Given the continuous improvement of neurosurgical and emergency care over the past century, more patients survive such head injuries, thus necessitating more than ever before a simple, safe, and durable means of correcting skull defects. In response, numerous techniques and materials have been devised as the art of cranioplasty has progressed. Although the goals of cranioplasty remain the same, the evolution of techniques and diversity of materials used serves as testimony to the complexity of this task. This paper highlights the evolution of these materials and techniques, with a particular focus on the implications for managing pediatric calvarial repair and emerging trends within the field.

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Section: Acrylicsmentioning

confidence: 48%

Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends

Feroze

Walmsley

Choudhri

et al. 2015

JNS

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“…Another key advantage of titanium is its natural osseointegration factor, which promotes active bone growth into the implant [41,42]. Studies have shown that titanium implants for cranial and maxillofacial applications have a lower survival rate (higher complication rate) than alterative materials such as PMMA [27]. Despite its lower Young's modulus than alterative metals, the value for titanium is higher than that of natural bone, leading to a lessened, but still present, risk of stress shielding [79].…”

Section: Discussionmentioning

confidence: 98%

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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“…Therefore, incidence of up to 20% described in medical literature should not be common. [1279141516171823] Moreover, once a cranioplasty flap is infected, usually flap removal is needed, which implicates a new surgery with bleeding and anesthetic risks, antibiotic treatment for at least 4 weeks, extending aesthetical disfiguring period and still requiring a new surgery to correct cranial defect and resulting in patient’s morbidity and hospital treatment costs increment.…”

Section: Discussionmentioning

confidence: 99%

“…Autologous bone cranioplasty has a lower incidence of postoperative infection when compared to synthetic prothesis, whose infection incidence may be as high as 20%. [127914151623] Even though surgeons apply all the procedures that significantly reduce postoperative infection, risks are applied (such as antiseptic preparation, use of sterilized matherials, adequate hand cleaning, and the use of antibiotic profylaxis during anesthesia induction), and the incidence of infection does not decrease from a certain percentage. No study has evaluated the impact over the infection incidence of antibiotic used in polymethylmethacrylate (PMMA) prothesis after cranioplasty.…”

Section: Introductionmentioning

confidence: 99%

Polymethylmethacrylate imbedded with antibiotics cranioplasty: An infection solution for moderate and large defects reconstruction

Worm¹,

Nascimento

Nicola

et al. 2016

Surg Neurol Int

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Background:In cases where autologous bone graft reconstruction is not possible (such as comminuted fractures, bone graft reabsorption, or infection) and the use of synthetic material is required, polymethylmethacrylate (PMMA) use is a safe and efficient solution. Studies comparing the incidence of postoperative complications between autologous and synthetic cranioplasty are heterogeneous, not allowing a conclusion of which is the best material for skull defects reconstruction. Current medical literature lacks prospective well-delineated studies with long-term follow-up that analyze the impact of antibiotic use in PMMA cranial reconstruction of moderate and large defects.Methods:A prospective series of patients, who underwent cranioplasty reconstruction with PMMA impregnated with antibiotic, were followed for 2 years. Authors collected data regarding demographic status, clinical conditions, surgical information, and its complications.Results:A total of 58 patients completed full follow-up with a mean group age of 40 years and a male predominance (77%). Major complications that required surgical management were identified in 5 patients, and 10 patients evolved with minor complications. Postoperative surgical site infection incidence was 3.2%.Conclusion:The infection rate in patients submitted to PMMA flap cranioplasty impregnated with antibiotic is significantly inferior comparing to the data described in medical literature. A lower infection incidence impacts secondary endpoints such as minimizing surgical morbidity, mortality, hospitalization period, and, consequently, costs.

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Comparison of acrylic and titanium cranioplasty^#

Cited by 50 publications

References 21 publications

Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends

Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends

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

Polymethylmethacrylate imbedded with antibiotics cranioplasty: An infection solution for moderate and large defects reconstruction

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Comparison of acrylic and titanium cranioplasty#

Cited by 50 publications

References 21 publications

Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends

Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends

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

Polymethylmethacrylate imbedded with antibiotics cranioplasty: An infection solution for moderate and large defects reconstruction

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Product

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Comparison of acrylic and titanium cranioplasty^#