Antibiotic impregnated methyl methacrylate [Neurosurgery Wiki]

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=====Antibiotic impregnated methyl methacrylate=====

A peri-operative bundle, which consisted of peri-operative [[vancomycin]] (4 doses), a barrier dressing through post-operative day (POD) 3, and de-colonization of the surgical incision using topical [[chlorhexidine]] from POD 4 to 7, was associated with reduced [[SSI]] rates and the need for re-do cranioplasties
((Le C, Guppy KH, Axelrod YV, Hawk MW, Silverthorn J, Inacio MC, Akins PT. Lower
complication rates for cranioplasty with peri-operative bundle. Clin Neurol
Neurosurg. 2014 May;120:41-4. doi: 10.1016/j.clineuro.2014.02.009. Epub 2014 Feb 
25. PubMed PMID: 24731574.
))
In short-term follow-up, vancomycin and tobramycin-impregnated polymethyl methacrylate (PMMA) reconstruction appears safe and effective in salvage cranioplasty
((Hsu VM, Tahiri Y, Wilson AJ, Grady MS, Taylor JA. A preliminary report on the 
use of antibiotic-impregnated methyl methacrylate in salvage cranioplasty. J
Craniofac Surg. 2014 Mar;25(2):393-6. doi: 10.1097/SCS.0000000000000655. PubMed
PMID: 24561365.
)).

Implantation of autologous cryopreserved bone has been associated with infection rates of up to 33%, resulting in considerable patient morbidity
((Hng D, Bhaskar I, Khan M, Budgeon C, Damodaran O, Knuckey N, Lee G. Delayed
Cranioplasty: Outcomes Using Frozen Autologous Bone Flaps. Craniomaxillofac
Trauma Reconstr. 2015 Sep;8(3):190-7. doi: 10.1055/s-0034-1395383. Epub 2014 Dec 
17. PubMed PMID: 26269726; PubMed Central PMCID: PMC4532567.
)).
----


The purpose of a study is to establish the safety and utility of antibiotic-impregnated polymethyl methacrylate (PMMA) for salvage cranioplasty.A prospectively maintained database of all patients who underwent salvage cranioplasty using vancomycin and tobramycin-impregnated methyl methacrylate from January 2011 to July 2013 was reviewed. Vancomycin and tobramycin were mixed in PMMA, which was then applied to a rigidly fixed titanium mesh for reconstruction. Patients' demographics, indications, and outcomes of this technique were evaluated.Nine patients (mean age: 47 years) underwent vancomycin and tobramycin-impregnated PMMA reconstruction with a mean follow-up of 9.3 months (range 3.5-23 months). On average, these patients underwent 4 procedures (range: 1-15), which included repeat craniotomy, debridement for infection, and failed reconstructions over the course of 3.6 years (range: 7 months to 14 years) before salvage cranioplasty. All patients required salvage cranioplasty due to infection, with the most common bacteria isolated in culture being Propionibacterium acnes (n = 3), multiresistant coagulase-negative Staphylococcus (n = 3), methicillin-resistant Staphylococcus aureus (n = 2), and Enterobacter (n = 2). The average size of the craniectomy defect was 130 cm(2), and there were no incidences of postoperative infection, postoperative complications, or need for revisions.To conclude, in short-term follow-up, vancomycin and tobramycin-impregnated PMMA reconstruction appears safe and effective in salvage cranioplasty. Our early report represents a proof of concept--the true test is whether these short-term successes translate to stable long-term results
((Hsu VM, Tahiri Y, Wilson AJ, Grady MS, Taylor JA. A preliminary report on the 
use of antibiotic-impregnated methyl methacrylate in salvage cranioplasty. J
Craniofac Surg. 2014 Mar;25(2):393-6. doi: 10.1097/SCS.0000000000000655. PubMed
PMID: 24561365.
)).