Predictive factors for bone flap infection after cranioplasty

Tabata, Shinya; Kamide, Tomoya; Suzuki, Kaima; Kurita, Hiroki

doi:10.1016/j.jocn.2022.02.020

Cited by 7 publications

(4 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This suggests that compromise of the viability of any flap type affects overall wound healing and increases the risk of implant exposure. 9,10,11 Our data suggest pre-and postoperative radiation therapy is not associated with implant exposure for all flap and implant types. The lack of correlation between radiation therapy and implant exposure is surprising, as current clinical acumen suggests radiation therapy is a likely risk factor for implant exposure.…”

Section: Discussionmentioning

confidence: 67%

See 1 more Smart Citation

Outcomes of Cranioplasty Reconstructions: Review of Cranioplasty Implants and Free Flap Coverage Variables that Affect Implant Exposure

et al. 2023

View full text Add to dashboard Cite

BackgroundComplex scalp wounds with cranial/dural involvement are challenging to reconstruct. Successful reconstruction can be achieved with cranial implants/hardware and free flap coverage. Wounds can breakdown and require revision procedures. We addressed reconstructive outcomes of different implants requiring free flaps.ObjectiveTo determine the factors associated with implant exposure.DesignMulti‐institutional retrospective review of 82 patients, 2000–2020, repaired with cranial implants and free flap coverage.ResultsImplant exposure occurred in 13/82 (16%) reconstructions. Flap atrophy or thinning leading to implant exposure occurred in 11/82 (13%) reconstructions, including partial flap atrophy OR 0.05 (95% CI 0.0–0.35) and total flap atrophy OR 0.34 (95% CI 0.02–19.66). Revision surgeries that occurred subsequent to flap reconstruction were also associated with implant exposure (OR 0.02 (95% CI 0.0–0.19)). Implant exposure was not associated with radiation therapy, patient health history, implant type, flap type, or postoperative complications.ConclusionsImplant exposure is associated with free flap atrophy, leading to inadequate implant coverage and the need for revision surgeries. Completing reconstruction with adequate soft tissue bulk and coverage and avoiding revision surgery may decrease the risk for implant exposure over time.Level of Evidence4 Laryngoscope, 2023

show abstract

Section: Discussionmentioning

confidence: 67%

“…Revision surgery was related to nonhealing scalp wounds, likely from flap compromise and wound breakdown. This suggests that compromise of the viability of any flap type affects overall wound healing and increases the risk of implant exposure 9,10,11 …”

Section: Discussionmentioning

confidence: 99%

Outcomes of Cranioplasty Reconstructions: Review of Cranioplasty Implants and Free Flap Coverage Variables that Affect Implant Exposure

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Factors that may affect rates of infection after cranioplasty include smoking 16 and diabetes. 17 These factors were similar between preprotocol and postprotocol groups.…”

Section: Discussionmentioning

confidence: 99%

Low-Cost Wound Healing Protocol Reduces Infection and Reoperation Rates After Cranioplasty: A Retrospective Cohort Study

Rae,

O'Neill,

Godil

et al. 2023

Neurosurgery

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: Cranioplasty infections are a common and expensive problem associated with significant morbidity. Our objective was to determine whether a wound healing protocol after cranioplasty reduced the rate of infections and to determine the value of this intervention. METHODS: This is a single-institution retrospective chart review of 2 cohorts of cranioplasty patients over 12 years. The wound healing protocol, consisting of vitamin and mineral supplementation, fluid supplementation, and oxygen support, was instituted for all patients aged older than 15 years undergoing cranioplasty. We retrospectively reviewed the charts of all patients over the study period and compared outcomes before and after protocol institution. Outcomes included surgical site infection, return to operating room within 30 days, and cranioplasty explant. Cost data were collected from the electronic medical record. We included 291 cranioplasties performed before the wound healing protocol and 68 postprotocol. RESULTS: Baseline demographics and comorbidities were comparable between preprotocol and postprotocol groups. Odds of takeback to operating room within 30 days were the same before and after the wound healing protocol (odds ratio [OR] 2.21 [95% CI 0.76-6.47], P = .145). Odds of clinical concern for surgical site infection were significantly higher in the preprotocol group (OR 5.21 [95% CI 1.22-22.17], P = .025). Risk of washout was higher in the preprotocol group (HR 2.86 [95% CI 1.08-7.58], P = .035). Probability of cranioplasty flap explant was also significantly higher in the preprotocol group (OR 4.70 [95% CI 1.10-20.05], P = .036). The number needed to treat to prevent 1 cranioplasty infection was 24. CONCLUSION: A low-cost wound healing protocol was associated with reduced rate of infections after cranioplasty with concomitant reduction in reoperations for washout, saving the health care system more than $50,000 per 24 patients. Prospective study is warranted.

show abstract

“…[11][12][13][14][15][16][17] As a regular procedure after DC, CP is associated with a high incidence of postoperative complications, including infection, epidural hematoma, ICH, hydrocephalus, seizure, and epidural/ subdural fluid collections. [18][19][20][21][22][23][24] Many studies suggest that the DC-CP interval and surgery materials may be related to complications after CP. [25][26][27] Whereas factors influencing postoperative complications remain controversial, there are very few reports concerning the relationship between brain collapse and postoperative complications.…”

mentioning

confidence: 99%

Optimal Timing of Cranioplasty and Predictors of Overall Complications After Cranioplasty: The Impact of Brain Collapse

Chen

Zheng

et al. 2023

Neurosurgery

View full text Add to dashboard Cite

BACKGROUND:The optimal timing of cranioplasty (CP) and predictors of overall postoperative complications are still controversial. OBJECTIVE: To determine the optimal timing of CP. METHODS: Patients were divided into collapsed group and noncollapsed group based on brain collapse or not, respectively. Brain collapse volume was calculated in a 3-dimensional way. The primary outcomes were overall complications and outcomes at the 12-month follow-up after CP. RESULTS: Of the 102 patients in this retrospective observation cohort study, 56 were in the collapsed group, and 46 were in the noncollapsed group. Complications were noted in 30.4% (n = 31), 24 (42.9%) patients in the collapsed group and 7 (15.2%) patients in the noncollapsed group, with a significant difference (P = .003). Thirty-three (58.9%) patients had good outcomes (modified Rankin Scale 0-3) in the collapsed group, and 34 (73.9%) patients had good outcomes in the noncollapsed group without a statistically significant difference (P = .113). Brain collapse (P = .005) and Karnofsky Performance Status score at the time of CP (P = .025) were significantly associated with overall postoperative complications. The cut-off value for brain collapse volume was determined as 11.26 cm 3 in the receiver operating characteristic curve. The DC-CP interval was not related to brain collapse volume or postoperative complications. CONCLUSION: Brain collapse and lower Karnofsky Performance Status score at the time of CP were independent predictors of overall complications after CP. The optimal timing of CP may be determined by tissue window based on brain collapse volume instead of time window based on the decompressive craniectomy-CP interval.

show abstract

Predictive factors for bone flap infection after cranioplasty

Cited by 7 publications

References 39 publications

Outcomes of Cranioplasty Reconstructions: Review of Cranioplasty Implants and Free Flap Coverage Variables that Affect Implant Exposure

Outcomes of Cranioplasty Reconstructions: Review of Cranioplasty Implants and Free Flap Coverage Variables that Affect Implant Exposure

Low-Cost Wound Healing Protocol Reduces Infection and Reoperation Rates After Cranioplasty: A Retrospective Cohort Study

Optimal Timing of Cranioplasty and Predictors of Overall Complications After Cranioplasty: The Impact of Brain Collapse

Contact Info

Product

Resources

About