Abstract
In patients who have undergone decompressive craniectomy (DC), subsequent cranioplasty is required to reconstruct cranial defects. Surgical site infection (SSI) following cranioplasty is a devastating complication that can lead to cranioplasty failure. The aim of the present study, therefore, was to identify predictive factors for SSI following cranioplasty by reviewing procedures performed over a 10-year period. A retrospective analysis was performed for all patients who underwent cranioplasty following DC between 2010 and 2020 at a single institution. The patients were divided into two groups, non-SSI and SSI, in order to identify clinical variables that are significantly correlated with SSI following cranioplasty. Cox proportional hazards regression analyses were then performed to identify predictive factors associated with SSI following cranioplasty. A total of 172 patients who underwent cranioplasty, including 48 who received customized three-dimensional (3D) printed implants, were enrolled in the present study. SSI occurred in 17 patients (9.9%). Statistically significant differences were detected between the non-SSI and SSI groups with respect to presence of fluid collections on CT scans before and after cranioplasty. Presence of fluid collections on computed tomography (CT) scan before (p = 0.0114) and after cranioplasty (p < 0.0000) showed significant association with event-free survival rate for SSI. In a univariate analysis, significant predictors for SSI were fluid collection before (p = 0.0172) and after (p < 0.0001) cranioplasty. In a multivariate analysis, only the presence of fluid collection after cranioplasty was significantly associated with the occurrence of SSI (p < 0.0001). The present study investigated predictive factors that may help identify patients at risk of SSI following cranioplasty and provide guidelines associated with the procedure. Based on the results of the present study, only the presence of fluid collection on CT scan after cranioplasty was significantly associated with the occurrence of SSI. Further investigation with long-term follow-up and large-scale prospective studies are needed to confirm our conclusions.
Highlights
Cranioplasty is required to reconstruct cranial defects for patients undergoing decompressive craniectomy (DC) to treat refractory intracranial hypertension due to traumatic brain injury, cerebral infarction, intracranial hemorrhage, and various causes of brain edema, or craniectomy for compound comminuted depressed and/or open/contaminated skull fractures [1,2,3,4,5]
The most commonly used materials for cranioplasty were Autologous bone flaps (ABF) (61.6%), 3D printed implants (27.9%), titanium mesh (7.6%), and polymethyl methacrylate (PMMA) (2.9%), was and we found no significant differences between the graft materials for the eventfree survival rates for Surgical site infection (SSI) following cranioplasty (Figure 4A)
The present study investigated predictive factors that may help identify patients at risk of SSI following cranioplasty and provide guidelines associated with the procedure
Summary
Cranioplasty is required to reconstruct cranial defects for patients undergoing decompressive craniectomy (DC) to treat refractory intracranial hypertension due to traumatic brain injury, cerebral infarction, intracranial hemorrhage, and various causes of brain edema, or craniectomy for compound comminuted depressed and/or open/contaminated skull fractures [1,2,3,4,5]. Recent advances in three-dimensional (3D) printing technology and medical imaging have enabled the production of custom-made prefabricated patient-specific synthetic implants, offering a precise fit [8, 18,19,20,21]. Despite these advances and the technical simplicity of the procedure, cranioplasty is associated with a high rate of complications, such as infection, bone resorption, postoperative hemorrhage, seizure, and hydrocephalus, which can increase the morbidity and mortality [6, 8, 9, 14, 22]. The aim of the present study was to identify predictive factors of SSI following cranioplasty by reviewing procedures performed over a 10-year period, including 172 cases, 48 of which involved the use of 3D printed patient-specific implants
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
