Article
Cranioplasty with customised implants – a more elaborate alternative to autologous bone flap reimplantation after decompressive hemicraniectomy?
Kranioplastie mit individuell angefertigten Implantaten – eine mögliche first-line Alternative zur Re-Implantation des autologen Knochendeckels nach dekompressiver Hemikraniektomie?
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Authors
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Christina Wolfert
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Dorothee Mielke
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Cranioplasty after decompressive hemicraniectomy (DC) is considered to be an easy neurosurgical intervention. Awareness has been sharpened due to high surgery-associated complication rates of up to 40% reported in literature. Hence, a progressive debate arises, whether autologous bone flaps should be primarily replaced by customized implants (CI) in order to hamper complications that are specifically allocated to autologous bone flap (ABF) reimplantation.
Therefore, we conducted a retrospective single center study comparing the complication rate of cranioplasty between one specific CI and ABF reimplantation.
Methods: We retrospectively analyzed data of a consecutive series of 44 patients (20 female, 24 male) that received a CI (Craniomosaic, OssDsign) and compared data to a historical cohort of 121 patients that underwent ABF reimplantation at our institution. P-value was calculated using the Chi2-Test, with a significant value of p <0.05.
Results: In total, 51 CI were used in 44 patients and compared to 121 ABF. One patient received two CI after bilateral DC; three patients received two implants and one patient three due to previous infections. Nine out of 51 patients that received a CI (17.6%) had a prior explantation, either of an ABF or a CI due to a previous infection.
Wound infection rate after ABF was 5.0% (n=6), and 9.8% (n=4) in CI (p=0.14). In three out of these patients (5.9%) skin closure was only feasible with a rotational skin flap due to prior wound heeling disorders. In two patients (3.9%), a superficial surgical revision was necessary due to skin break through, while wound dehiscence was only found in one patient (0.8%) after ABF. Aseptic bone necrosis occurred in 21 patients (17.4%) after ABF reimplantation.
Conclusion: The risk of aseptic bone necrosis in ABF is high. The use of a customized implant eliminates that risk. In the literature, it is assumed that the primary use of a CI is linked to a higher infection rate. However, despite being used in a subpopulation with a higher risk for infection, we could not show a significant difference in the infection rate. In conclusion, CI are a good alternative to ABF and should be either used as primary implant or, at least, in patients with risk factors for aseptic bone necrosis.
