Bone flap resorption: Risk factors for the development of a long-term complication following cranioplasty after decompressive craniectomy.
ABSTRACT Aseptic bone flap resorption (BFR) is a known long-term complication after cranioplasty (CP). We analyzed our institutional data in order to identify risk factors for BFR. From October 1999 to April 2012, 254 patients underwent CP after decompressive craniectomy (DC) at our institution and had a long-term follow-up period of more than 1 year after CP (range 12-146 months). Overall, BFR occurred in 10 of 254 patients as long-term complication after CP (4%). BFR developed more often in patients aged ≤ 18 years (p=0.008), in patients who previously underwent DC due to traumatic brain injury (p=0.04), and in patients with multiple fractures within the reinserted bone flap (p=0.002). Furthermore, BFR developed significantly more often in patients who underwent cranioplasty ≤ 2 months after DC (p=0.008), as well as in patients with wound healing disturbance or abscess as an early complication after the CP procedure (p=0.01). The multivariate analysis of the present data identified the presence of multiple fractures within the bone flap (p=0.002, OR 10.3, 95% CI 2.4-43.8), wound infection after CP (p=0.003, OR 12.3, 95% CI 2.3-65.3), and cranioplasty performed ≤ 2 months after DC (p=0.01, OR 6.3, 95% CI 1.5-26.3) as independent risk factors for the development of BFR after CP in a large series with long term follow-up. This might influence future surgical decision making, especially in patients fulfilling high risk criteria for developing BFR.
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ABSTRACT: Renewed interest has developed in decompressive craniectomy, and improved survival is shown when this treatment is used after malignant middle cerebral artery infarction. The aim of this study was to investigate the frequency and possible risk factors for developing surgical site infection (SSI) after delayed cranioplasty using autologous, cryopreserved bone. This retrospective study included 74 consecutive patients treated with decompressive craniectomy during the time period May 1998 to October 2010 for various non-traumatic conditions causing increased intracranial pressure due to brain swelling. Complications were registered and patient data was analyzed in a search for predictive factors. Fifty out of the 74 patients (67.6 %) survived and underwent delayed cranioplasty. Of these, 47 were eligible for analysis. Six patients (12.8 %) developed SSI following the replacement of autologous cryopreserved bone, whereas bone resorption occurred in two patients (4.3 %). No factors predicted a statistically significant rate of SSI, however, prolonged procedural time and cardiovascular comorbidity tended to increase the risk of SSI. SSI and bone flap resorption are the most frequent complications associated with the reimplantation of autologous cryopreserved bone after decompressive craniectomy. Prolonged procedural time and cardiovascular comorbidity tend to increase the risk of SSI.Acta Neurochirurgica 02/2014; 156(4). DOI:10.1007/s00701-013-1992-6 · 1.79 Impact Factor
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ABSTRACT: Increasing use of decompressive craniectomies has led to a corresponding number of cranioplasties performed to replace the subsequent bone defect created. We aimed to evaluate the morbidity associated with cranioplasty using an autologous bone flap sterilised in an autoclave. We retrospectively analysed data from 149 patients who underwent cranioplasty following decompressive craniectomy during the time period January 1998 to December 2012. Autologous bone flaps were sterilised in an autoclave and stored in a refrigerator at a temperature of 8 degrees above zero until cranioplasty was performed. Complications were registered and patient data were analysed in order to identify risk factors for surgical site infection and bone flap resorption after cranioplasty. Only the patients with a follow-up period of >24 months were included in the analysis of bone flap resorption (110 patients). Surgical side infection occurred in only five patients (3.3%), whereas bone flap resorption developed in 22 patients (20%). The multivariate analysis of the presented data identified the operating time of >120 min (p = 0.0277; OR, 16.877; 95% CI, 1.364-208.906) and the presence of diabetes mellitus (p = 0.0016; OR, 54.261; 95% CI, 4.529-650.083) as independent risk factors of development of infection and the presence of ventriculo-peritoneal (VP) shunt (p < 0.0001; OR, 35.564; 95% CI, 9.962-126.960) as independent risk factor of development of the bone flap resorption. Reimplantation of the autoclaved autologous bone flap following decompressive craniectomy is a simple and cheep alternative to other techniques and is available to any institution that provides autoclaving sterilisation services. This method is associated with a low rate of surgical site infection, but with a significant rate of the bone flap resorption.Acta Neurochirurgica 01/2015; 157(3). DOI:10.1007/s00701-014-2333-0 · 1.79 Impact Factor
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ABSTRACT: The number of patients who need cranioplasty after decompressive craniectomy has increased. In most cases, autologous bone flaps are used for cranioplasty, and there have been reports of the complication of bone flap resorption. Based on these facts, we analysed patients who underwent cranioplasty in our institution to learn about potential risk factors of cranioplasty. We performed a retrospective study and analysed 58 patients who underwent cranioplasty between 2006 and 2013. We found that patients with a defect size >120cm(2) whose reimplantation was delayed tended to have a risk of bone flap resorption. Patients with delayed reimplantation and a defect size >120cm(2) show a tendency of aseptic bone flap resorption. In these cases, a patient-specific implant (PSI) could be the first choice material for this procedure to reduce the rate of this complication.Clinical neurology and neurosurgery 05/2014; 120:64-7. DOI:10.1016/j.clineuro.2014.02.014 · 1.30 Impact Factor