Effect of Early Surgery, Material, and Method of Flap Preservation on Cranioplasty Infections: A Systematic Review

Yadla, Sanjay; Campbell, Peter G.; Chitale, Rohan; Maltenfort, Mitchell; Jabbour, Pascal; Sharan, Ashwini

doi:10.1227/neu.0b013e31820a5470

Cited by 235 publications

(182 citation statements)

References 31 publications

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“…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. Based on these limited data, we can make no recommendation about the timing of pediatric cranioplasty.…”

Section: Timing Of Cranioplastymentioning

confidence: 74%

“…In the previously cited systematic review of adult cranioplasties, the authors found 13 studies in which the risk of infection due to autograft versus allograft cranioplasty was compared. 20 In 9 of these studies (only 1 of which reached statistical significance), autograft was associated with a lower risk of infection, while in 4 of these studies (again, only 1 of which reached statistical significance), allograft was associated with a lower risk. As expected, meta-analysis showed no difference in the infection rate based on the material used.…”

Section: Materials Usedmentioning

confidence: 93%

“…Finally, a large systematic review of adult patients found that method of flap storage had no effect on the rate of cranioplasty infection. 20 …”

Section: Methods Of Storagementioning

confidence: 99%

“…However, using autologous bone for cranioplasty has been suggested to result in a high incidence of bone resorption, particularly in the pediatric population: as high as 50% in that population, versus 0%-7% in the adult population. 8,20 Similarly, it has been reported to result in a high rate of surgical site infection: an average of 7.9% across 18 studies, according to a recent large-scale systematic review of postcranioplasty complications in adult patients. 20 This result suggests that surgical site infection is a significant cause of morbidity following cranioplasty in adults.…”

mentioning

confidence: 99%

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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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Section: Timing Of Cranioplastymentioning

confidence: 74%

Section: Materials Usedmentioning

confidence: 93%

“…Finally, a large systematic review of adult patients found that method of flap storage had no effect on the rate of cranioplasty infection. 20 …”

Section: Methods Of Storagementioning

confidence: 99%

mentioning

confidence: 99%

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Outcomes of cranioplasty following decompressive craniectomy in the pediatric population

Rocque

Amancherla

Lew

et al. 2013

PED

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“…The usual method to preserve an excised bone flap is to place it in a subcutaneous pocket in the abdominal wall or anterolateral thigh of the patient (subcutaneous preservation/intracorporeal storage) [18]. The second method is the Extracorporeal storage by cryopreservation (freezing or freeze drying) of the bone flap in a bone bank at around -70°or so [19]. In this method, there is destruction of bone proteins so the bone flap does not revitalize, and chances of resorption and SSI after cranioplasty is more [20][21][22].…”

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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Bioinspired Collagen Scaffolds in Cranial Bone Regeneration: From Bedside to Bench

Lee

Volpicelli

2017

Adv Healthcare Materials

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Calvarial defects are common reconstructive dilemmas secondary to a variety of etiologies including traumatic brain injury, cerebrovascular disease, oncologic resection, and congenital anomalies. Reconstruction of the calvarium is generally undertaken for the purposes of cerebral protection, contour restoration for psychosocial well-being, and normalization of neurological dysfunction frequently found in patients with massive cranial defects. Current methods for reconstruction using autologous grafts, allogeneic grafts, or allo-plastic materials have significant drawbacks that are unique to each material. The combination of wide medical relevance and the need for a better clinical solution render defects of the cranial skeleton an ideal target for development of regenerative strategies focused on calvarial bone. With the improved understanding of the instructive properties of tissue-specific extracellular matrices and the advent of precise nanoscale modulation in materials science, strategies in regenerative medicine have shifted in paradigm. Previously considered to be simple carriers of stem cells and growth factors, increasing evidence exists for differential materials directing lineage specific differentiation of progenitor cells and tissue regeneration. In this work, we review the clinical challenges for calvarial reconstruction, the anatomy and physiology of bone, and extracellular matrix-inspired, collagen-based materials that have been tested for in vivo cranial defect healing.

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Effect of Early Surgery, Material, and Method of Flap Preservation on Cranioplasty Infections: A Systematic Review

Abstract: Analysis of the best current evidence suggests that early surgery, implant material, and method of flap preservation have no effect on the rate of cranioplasty infections.

Cited by 235 publications

References 31 publications

Outcomes of cranioplasty following decompressive craniectomy in the pediatric population

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

Bioinspired Collagen Scaffolds in Cranial Bone Regeneration: From Bedside to Bench

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